Vet issue: WWYD?

Illusion100

Well-Known Member
Joined
17 January 2014
Messages
3,625
Location
Probably on my way to A&E
Visit site
Ok so a friends horse has had ongoing bilateral forelimb lameness issues. Diagnosis was LGL and mud fever/oedema issues, think cankles!

X-rays had been taken etc and nothing was going on with the feet, i.e nothing major of note/no rotation/navicular etc. This lameness claim (although with a wishy washy diagnosis) has been covered via insurance but runs out very soon.

Several vets from the same practice have been assessing/managing this horse, however a new Vet member of staff commented on the severe fetlock arthritis. X-rays were emailed over and I couldn't see any severe arthritis, areas of mild arthritic change yes but nothing to get excited about. I asked who this Vet was and it turns out they are foreign so I suspect that 'severe' and 'chronic' have been mixed up in translation. However, this Vet quickly realised that my friend had never been previously advised about any arthritic change. :eek:

To be sure I had the x-rays checked again by a Vet friend and the diagnosis was mild arthritic change in the fetlock joint. The horse has been managed as a laminitic and of course if arthritis is also a factor then the management would have been different plus obviously anti-inflammatories and possibly steriod injections may/could have been utilised/considered to investigate usefulness in short-term and long-term management etc. Now time is really running out on this claim.

Would you be unhappy with the Vets and would you bring it up? If yes, what would you consider a fair and satisfactory course of action/compensation to be? If no, why?

Thank you all. :)

The lameness is significant enough however as we know change seen on x-ray does not necessarily equate to the level of pain felt so it's a grey area to assess without blocking.
 
Last edited:

PaddyMonty

Well-Known Member
Joined
11 October 2006
Messages
8,349
Location
Northampton
Visit site
all depends on how significant the arthritic change is impacting on the horse. No impact = No issue but should still have been mentioned.
Significant impact then you are looking at incorrect diagnosis so much more serious.
 

Maesfen

Extremely Old Nag!
Joined
20 June 2005
Messages
16,720
Location
Wynnstay - the Best!
photobucket.com
Quick answer - yes, I would be unhappy that none of the earlier vets had spotted the fetlock problems but as the owner, I would be kicking myself for not insisting the whole leg was done instead of just the feet and surely they must have noticed themselves how the action or behaviour of that joint was altering even just as they picked it up.
Compensation wise, I don't think it will happen but they need to write to the practice manager/chief vet explaining their problems and ask if there's some way the bill can be amended due to mis-diagnosis; it won't come off the drugs or x-ray charges but they might get visit charges reduced. I'd also let their insurance know asap and fall on their mercy.
 

ihatework

Well-Known Member
Joined
7 September 2004
Messages
21,346
Visit site
Quick answer - yes, I would be unhappy that none of the earlier vets had spotted the fetlock problems but as the owner, I would be kicking myself for not insisting the whole leg was done instead of just the feet and surely they must have noticed themselves how the action or behaviour of that joint was altering even just as they picked it up.
Compensation wise, I don't think it will happen but they need to write to the practice manager/chief vet explaining their problems and ask if there's some way the bill can be amended due to mis-diagnosis; it won't come off the drugs or x-ray charges but they might get visit charges reduced. I'd also let their insurance know asap and fall on their mercy.

I'd be careful how OP plays this.

If fetlock arthritis is a 'new' diagnosis then you have 12 months to play with on insurance ....
 

AnShanDan

Well-Known Member
Joined
2 May 2007
Messages
1,692
Visit site
Seems unlikely any reputable vet practice would have missed diagnosis of arthritis, even with co existing conditions. Surely nerve blocks have been done at the outset?
 

hairycob

Well-Known Member
Joined
8 May 2005
Messages
3,933
Location
Bedfordshire
Visit site
It might not necessarily be a new claim if it's the same set of tests - depends on the insurer. Key word is incident rather than condition. Incident can cover a set of things presenting/found at the same time.
 

Illusion100

Well-Known Member
Joined
17 January 2014
Messages
3,625
Location
Probably on my way to A&E
Visit site
Apparently the horse won't tolerate being blocked however they only ever wanted to block the foot afaik.

Yes, as far as insurance goes there are a few loopholes BUT the Vets would need to play ball as well.

Here are the x-rays of significance, the arthritic change is evident so why it was not mentionned previously or even at the time, I will never know! I have had to crop off more than I'd have liked to avoid displaying sensitive info for obvious reasons but they do the job.



 

Illusion100

Well-Known Member
Joined
17 January 2014
Messages
3,625
Location
Probably on my way to A&E
Visit site
The head of the nail/screw **appears** to be in the foot and travelling downwards. All shoe-nails that I've seen, have travelled upwards.

I'm happy to be told though! :)

Alec.

It's not a horse shoe nail and it's not in the horses foot. It's a screw in a block under the horses foot, various types of blocks are used i.e angled depending on what view needed for x-ray. It's just that in this case it is a confusing artefact but nothing of relevance. :)
 

chaps89

Well-Known Member
Joined
8 July 2009
Messages
8,518
Location
Surrey
Visit site
Just to clarify, are these more recent x-rays that have been taken, or is it that a new vet has reviwed the old x-rays?
I'm fairly used (sadly) to looking at x-rays and to me the changes are obvious, so I'm not sure how a vet could miss them?!
I have a horse you can't block, it's a real pita when trying to diagnose lameness, the owner has my sympathy!
My horse has high and low ringbone in all 4 feet, the x-rays are pretty scarey. However when she had a bone scan, they didn't light up as active at all, and in fact 2 subsequent sets of x-rays later, very little if anything has changed- it was a coincidental finding.
Depending on the age of the x-rays, can new ones be taken to see if there's further changes or can they be compared against older x-rays?
If it's a case of horse has been lame for x period of time with no found cause (because nerve blocks weren't possible and x-rays showed nothing) and now new/different x-rays have been done, you'll be hard pushed to convince the insurers it's not all the same thing. I would therefore be pushing back to the vets to question why they didn't explore other areas sooner? And if it's that they missed the changes on the original x-rays I'd be most unimpressed and really seeking some answers from the vet.
 

spacefaer

Well-Known Member
Joined
3 March 2009
Messages
5,682
Location
Shropshire
Visit site
That's not a nice pair of plates, is it?

Treatment for the laminitis could well have exacerbated the pain from the arthritis.

I would be raging, to be honest. It doesn't cost that much to do a couple of plates for each fetlock. They seem to have stopped at the first possible diagnosis without considering others. Lazy or incompetent?

I've just had a very similar situation in horse presenting with bilateral forelimb lameness, and tbh, ,we went straight to xrays of feet and fetlocks.

I would be kicking off to the vets and seeing what they can suggest to ameliorate the situation. Obviously, different/better/more appropriate treatment for the horse has to be the first priority, and given that the treatment so far has not fixed him, it would suggest to me that the lameness is more than likely to be due to the untreated issue.

I would expect a decent offer on the fees from the accounts department too.
 

Illusion100

Well-Known Member
Joined
17 January 2014
Messages
3,625
Location
Probably on my way to A&E
Visit site
Just to clarify, are these more recent x-rays that have been taken, or is it that a new vet has reviwed the old x-rays?
I'm fairly used (sadly) to looking at x-rays and to me the changes are obvious, so I'm not sure how a vet could miss them?!
I have a horse you can't block, it's a real pita when trying to diagnose lameness, the owner has my sympathy!
My horse has high and low ringbone in all 4 feet, the x-rays are pretty scarey. However when she had a bone scan, they didn't light up as active at all, and in fact 2 subsequent sets of x-rays later, very little if anything has changed- it was a coincidental finding.
Depending on the age of the x-rays, can new ones be taken to see if there's further changes or can they be compared against older x-rays?
If it's a case of horse has been lame for x period of time with no found cause (because nerve blocks weren't possible and x-rays showed nothing) and now new/different x-rays have been done, you'll be hard pushed to convince the insurers it's not all the same thing. I would therefore be pushing back to the vets to question why they didn't explore other areas sooner? And if it's that they missed the changes on the original x-rays I'd be most unimpressed and really seeking some answers from the vet.

X-rays are approx 8 months old. Unfortunately all I can do is give the owner advice and I don't know whether new x-rays will be taken or any other investigations. I think the Vets have some explaining to do!
 

Illusion100

Well-Known Member
Joined
17 January 2014
Messages
3,625
Location
Probably on my way to A&E
Visit site
That's not a nice pair of plates, is it?

Treatment for the laminitis could well have exacerbated the pain from the arthritis.

I would be raging, to be honest. It doesn't cost that much to do a couple of plates for each fetlock. They seem to have stopped at the first possible diagnosis without considering others. Lazy or incompetent?

I've just had a very similar situation in horse presenting with bilateral forelimb lameness, and tbh, ,we went straight to xrays of feet and fetlocks.

I would be kicking off to the vets and seeing what they can suggest to ameliorate the situation. Obviously, different/better/more appropriate treatment for the horse has to be the first priority, and given that the treatment so far has not fixed him, it would suggest to me that the lameness is more than likely to be due to the untreated issue.

I would expect a decent offer on the fees from the accounts department too.

Thanks for your opinion, I wouldn't be too impressed with Vets either!

Bute and low level exercise is the ideal management plan atm, as personally I believe that although there are numerous aspects of bony change, the majority aren't particularly significant apart from around the sesamoids and an area within the fetlock joint capsule. Will be interested to see how bute helps with this horse.
 

Casey76

Well-Known Member
Joined
16 July 2011
Messages
3,651
Location
North East, UK
Visit site
Could you expand on your interpretation of the x-rays please? :)

I'm not a professional in any way, shape or form, so this is just my uneducated opinion (though I've examined my own horses xrays (4 different horses) and had them explained to me in depth).

The first plate clearly show the lateral side of P1 is longer than the medial side, this will contribute to any number of conformational gait disorders, putting pressure on the lateral side (which can be seen in the increased calcification between P1 and the cannon). The joint facets (intra-articular spaces) themselves appear to be clean.

The second plate isn't a clean shot, and it appears that the horse has moved while the radio was taken, however from the ground up: There are areas of what appears to be white line separation/gas inclusions at various points. There is a broken back HPA, and although there is no coronet marker, the toes look excessively long contributing to this angle. This angle obviously puts strain on the DDFT and navicular bursa. The navicular bone itself looks fairly normal/clean (no erosions or calcifications - that I can see on this image). For me, what is striking is the excessive skin thickening and folding at the fetlock. On the plate it appears that there is no necrosis or overt infection, however I'm willing to bet that they are extremely sore, and there will be evidence of some superficial infections (like tinea ssp) unless kept very dry.

On the second plate I wouldn't want to comment any higher than the middle of P1 due to the echo/artifacts of the unclean radio.
 

Wagtail

Horse servant
Joined
2 December 2010
Messages
14,816
Location
Lincs
Visit site
I'm not a professional in any way, shape or form, so this is just my uneducated opinion (though I've examined my own horses xrays (4 different horses) and had them explained to me in depth).

The first plate clearly show the lateral side of P1 is longer than the medial side, this will contribute to any number of conformational gait disorders, putting pressure on the lateral side (which can be seen in the increased calcification between P1 and the cannon). The joint facets (intra-articular spaces) themselves appear to be clean.

The second plate isn't a clean shot, and it appears that the horse has moved while the radio was taken, however from the ground up: There are areas of what appears to be white line separation/gas inclusions at various points. There is a broken back HPA, and although there is no coronet marker, the toes look excessively long contributing to this angle. This angle obviously puts strain on the DDFT and navicular bursa. The navicular bone itself looks fairly normal/clean (no erosions or calcifications - that I can see on this image). For me, what is striking is the excessive skin thickening and folding at the fetlock. On the plate it appears that there is no necrosis or overt infection, however I'm willing to bet that they are extremely sore, and there will be evidence of some superficial infections (like tinea ssp) unless kept very dry.

On the second plate I wouldn't want to comment any higher than the middle of P1 due to the echo/artifacts of the unclean radio.

I too noticed the skin folds and thickening. Regarding P1; it looks like there is a bit of remodelling at the tip which is suggestive of laminitis too. OP, my mare had chronic laminitis for 3 years with no rotation, so I would still suspect laminitis as a major cause of the lameness. Also, I would not like steroids used to treat any arthritis if there was any possibility of laminitis. Although the arthritic changes are mild, they often cause far more pain than more advanced remodelling because the joints are more movable and so the surfaces grate on each other more.
 

SusieT

Well-Known Member
Joined
15 September 2009
Messages
5,915
Visit site
I think you are unreasonable to try and diagnose the horse via the internet forum when it is under vet care- you don't know the full ins and outs - its not your horse. If they aren't happy with the current vet a second veterinary opinion from an expert should be sought. I find it odd to ask internet people for advice on an x-ray - not knowing it they are people with any idea or not!
 

Illusion100

Well-Known Member
Joined
17 January 2014
Messages
3,625
Location
Probably on my way to A&E
Visit site
I think you are unreasonable to try and diagnose the horse via the internet forum when it is under vet care- you don't know the full ins and outs - its not your horse. If they aren't happy with the current vet a second veterinary opinion from an expert should be sought. I find it odd to ask internet people for advice on an x-ray - not knowing it they are people with any idea or not!

A diagnosis was not needed but thank you for your imput.
 
Top