Unethical vet? would you keep working a lame horse?

[mrussell]

My horse was 1/10th lame after coming in from the field with a lump on her foreleg.

We boxed her to the vet who said thatw e could either keep working her til she went lame enough to diagnose or bring her in the following week for a full set of tests.

We went for the tests.

The first set were inconclusive so he suggested a months box rest with half an hours ridden exercise a day.

She has continued to show increasing lameness so we had him out again. He had thought it was foot pain but now wonders if its higher up the leg. He wasnt us to keep exercising her to "maintain" her lameness so he can have another look next week when hes not so busy.

Im really annoyed. Im terrified that she has a fracture (the lump is still swollen but not hot so he dismissed it as beng irrelavant).

I really like this vet and I know he is a small concern so finds it hard to squeeze you in...but Im thinking that if he cant find whats wrong without making ehr worse, then he should be referring us to someone who can.

What would you do?

 

[Halfstep]

What sort of tests? I would be having the lump x-rayed as it might be a fractured splint.

Horses that are 1/10 lame are very difficult to diagnose as nerve blocking is usually inconclusive with such low level lameness. It seems odd that the vet is disregarding the most obvious thing - the lump. One would think he would start with that and eliminate it first.

 

[harrihjc]

I've just been advised to work my lame horse as normal, I was a bit surprised at this advice, and a week later he's no better and I'm really worried

Admittedly I haven't worked him as normal, he's had a dramatically reduced workload, and had nearly 2 weeks off before the vet came.

 

[harrihjc]

OMG just read it again, and Flash is 1/10 lame with a lump on his splint! Although this appeared a week into his lameness and there was a cut too, he did it in the stable

 

[OrangeEmpire]

When Jack was v ill prior to his diagnosis of arthritis in his neck, the vet had me work him consistently - the idea was to maintain his lameness to that they actually had some kind of 'constant' to measure his progress by. But that being said my vet instantly had him booked in for xrays, visits to Horse Hosp. and later full body scans so I knew she was being proactive about it. Stupid thing was that whenever he went to see a specialist the adrenalin of travelling made him sound again!

I certainly don't like the sound of her increasing lameness and I would be pushing for xrays if nothing else. Jack's was maintained at a constant by work, not made worse.

 

[mrussell]

The lump is on the canon and the vet said it isnt a splint... its just a bruise. The swelling extends down from it to the fetlock. Its reduced in size but initially the fluid felt gritty. No sensitivity or heat.

An inital "block" led him to diagnose low grade soft tissue damage. However, as she has got significantly worse with rest and gentle exercise, he came to re-block before sending for an MRI only to find that the block now had no effect...at this point he admitted that it was marginal the first time but he thought it was an "obvious diagnosis"

and that rest/recuperation was the key.

 

[Halfstep]

When you say the swelling extends to the fetlock, where does the swelling start?

 

[zigzag]

get the lump x-rayed! My mare is 1/5 lame and she is now on 6 wks box rest, she has a fracture (though it was a splint on outside of her leg that has fractured) no heat either

 

[Christmas Crumpet]

Having brought my horse back into work after a tendon injury he didn't feel right all over so got the vet out who specialises in lameness. He said that my horse was slightly lame on his bad leg but that it wasn't the tendon and to keep walking him which I've done and also to have different shoes put on him. He also said that his back muscles and neck muscles had completed seized up so we've been working on them. I've done exactly as he said and my horse is back to his usual lovely. wonderful self.

I didn't have any issues with not going with what he said because he's qualified and I'm not. I guess it depends on how much you trust your vet really!! With 1/2 ridden exercise a day I'm assuming he's only suggesting walking?

 

[S_N]

My 1st reaction to this is 2nd opinion! Is this an equine vet?

 

[kerilli]

i had a horse with a very very slight lameness behind... only visible because she didn't quite track up on one side in walk, not trot or canter, and slight enough that dressage judges at Advanced level never noticed it.
my vet advised me to work her hard enough to make it worse so that they could determine exactly what it was.
erm, no, thank you very much. so i'm to take a 1% lame horse and risk making it much much worse? i gave her time off instead, and she came totally sound, and carried on eventing at A level.
sorry, but vets are businessmen too, and they make a lot of money out of us! advising me to give the horse months off would not have made them any money...

 

[henryhorn]

We have had this advice in the past, so it's not unusual, but with a lump I'd be asking for X rays.. (though he's right if it were a fracture in my experience it's normally pretty swollen and sore)
I can see in his opinion it will either present something obvious like a swelling or pus in the foot, and it sounds like he thinks it's something fairly minor, but dammit, the horse isn't rideable and a diagnosis would be helpful.
You're in a very difficult position now having had him out twice, but I think I would probably ask for a referral or just find someone else who you know is recognised as good.
As for saying he is busy..words fail me, I'm so lucky in the vet we have, who would never ever say that, if necessary he would send a colleague and confer together about it. What happens in an emergency if he's so busy?

 

[mrussell]

to the front of the inside of the cannon..around the height of the splint bone but not in the same location. (that is, its definately on the cannon and not the splint bone). Normally the bone follows down nice and straight with the fetlock forming a "knobble" but the angle is now filled, if you catch my drift. It feels like a blister under the skin. As I said though, no sesitivity and no heat, no mtter how hard its pressed.

 

[henryhorn]

If it feels like a blister it may well be a blood blister...
One of ours had one (I looked at the vet in astonishment when he suggested it) but he said just give it a few days to a week and it will disappear, and it did..
Looking at the clues though I wonder if this isn't an abcess in the foot quietly brewing away and nothing to do with the lump?

 

[Halfstep]

If the angle between the fetlock joint and the cannon bone is filled, that is quite substantial swelling, if I understand the description correctly. I would be having this area x-rayed even if only to eliminate it. If something like this presents at the same time as the onset of lameness it seems daft to discount it and look for invisible signs elsewhere. I agree with henryhorn - it might well be something else, but if the swelling is as I imagine it I would be having it investigated.

 

[mrussell]

Just got back from a second opinion....

nerve blocks had little effect and the problem has now been localised to between the fetlock and the knee. We are taking her back next week for some more specific tests and scans.

We had to very experienced vets working on her who feel that its likely to be an wrenched joint.... as there is no sign of any major tendon or ligament damage. The blcoks ruled out abscess... he said she is slightly fottsore on both fronts but he thinks thats from the farrier having cut her toe right back last week.

They want her box rested until she is back next week.

I feel SO much better.... I know Im no further forward but I feel I am now in the hands of the experts...

Thansk for listening to me ramble on guys... its such a worry!

 

[harrihjc]

I'm glad you've had a second opinion, my second opinion after the same advice also put my horse on box rest straight away and she's coming out to look at him tonight. I hope your horse makes a quick recovery now the right action is being taken

 

[cellie]

You have just described what I have been treating my horse for since June a sounds like a bruised cannon bone .The fluid under the skin at the front of the cannon bone goes up and down until it settles.My vet did the xrays we gave him time off and restricted turnout with support.Apparently excercise helps the bone area strengthen and the area is much stronger so it shouldnt ever be a problem again.This all went well until 6 weeks ago when he felt better and went crazy in his field and did his tendon on the same leg so we are back to box rest at night and restricted turnout.Good luck with your new vet.

 

[fourstarhels]

As a vet, I find it rather offensive to see generalising comments suggesting that we would cause a horse to suffer for the sake of making money (see post by kerilli). 99% of vets have the welfare of the animal at the forefront of any procedure that they undertake. I've gone through 5 years of hard study and have to put up with rubbish wages and stupidly long hours...because I love animals. If all I cared about was money, I would have chosen a different career.

As for the concerns raised by mrussell, they are understandable. However, 1/10th lame is really not very lame at all...a suprising number of horse owners ride and compete horses that are 1/10th lame without realising. The horse would probably be sound on the straight. If an owner wants diagnosis and treatment for a barely lame horse, then often the only way to localise the problem is through joint or nerve blocks (after a thorough clinical examination) - you said yourself that your second referral vet was able to identify the problem as being between the fetlock and the knee in this way. well, the only a joint/nerve block is of any use is if the horse is consistently lame. So yes, sometimes the lameness has to be exacerbated, which shouldn't be at all detrimental to a 1/10th lame horse, provided a thorough clinical exam has ruled out fractures and tendon injuries. After rest, the horse would go back to being the same soundness that he was before. the alternative is to guess an appropriate treatment (usually just rest the horse) which is all very well, but it could mean the lameness remains ongoing and unresolved.

I should add, however, that the decision should always rest with the owner, and if your vet suggests anything that gives you concern, you should discuss this with your vet and see if the are any alternatives. If you are still unhappy, seek a second opinion. Sometimes there is more than one right way to treat or diagnose a problem.

Sorry for the essay, just felt that I had to defend my proffession!

 

[kerilli]

i never said that a vet "would cause a horse to suffer for the sake of making money", but i have in the past been advised to take a very very slightly lame horse (detectable only in walk, not in trot or canter) and work her much harder in order to make it worse, so the vet could determine the problem.
i didn't, because that to me was ridiculous - turn a minor problem into a major, possibly career-ending one? i don't think so. i went against the vet's advice and rested the horse, the problem disappeared after a few months, she came back to full work (Advanced eventing) and stayed totally sound.
if i said my ankle was sore, would you advise me to go and run a marathon on it? i doubt it!
i trust my vets implicitly, but when it comes down to it, i do not think they can possibly care as much about my horse as i do. i know that however nice they are, i am just another client to them, whereas my horses are my life and my world, and irreplaceable.