Veterinary follow ups and success statistics

S

Speedyfluff

Well-Known Member
Joined
7 July 2015
Messages
338
Location
Midlands
Visit site
Having had decades of experience of having horses treated by veterinary hospitals, as well as many horses I have worked with, one of the most often asked questions from owners is "What chance does my horse have of returning to full fitness?" or "What percentage success rate does this operation/treatment have?" And vets invariably have an answer for you, often a statistic. However, how do we know these are bonafide figures? I have been to several hospitals on many occasions, and also used several veterinary practices. Not once has the hospital ever rung me, or an owner to check if the treatment has actually worked. So where do they get their figures from? Are they just happy to take our money and tell us any old rubbish, just to make us feel better? If I were a vet, I would WANT to know whether a treatment has worked and ask for feedback a year down the line on any animal I had treated. Why doesn't this seem to happen?
 
The vets actually did contact us by email to see how the horse was doing following a fairly simple op, he was recovering well from the op but not from the injury he acquired while at the vets, funnily enough they didn't want to know about that, would give no help or advice on dealing with the original injury as we had to change the rehab due to injury 2, so I suppose it will be down as a successful op, which it was, but with no mention of the fact the "short" rehab has ended up taking over two years and we are still unsure whether he will cope with full work.

The colic op horse certainly had no follow up that I can remember, out local vet came and assessed, took out stitches but I moved area while he was still on part box rest so they will have no idea that it was very successful and he lived a normal life for a further 12 years, yet we are always hearing statistics quoted about colic ops having a poor long term prognosis.

I think most ops are considered successful if the horse survives and goes home.
 
I suspect in the majority of cases they are guesstimate figures based on a vet's personal experience. I was reading an interesting article a while ago about the lack of evidence based practice available for vets. In order for the types of figures you describe to be relied on, there needs to have been a study done of a sample population under some controlled conditions (or at least some consideration of the type of horse, consistency of treatment and equivalence of aftercare) and this is quite rare, for obvious reasons.
I do think that vets should make this more obvious when discussing the prognosis of a given treatment.
 
I've been contacted twice for follow up.

Firstly a study of foot conditions where the clinic that did the MRI were following up outcomes. There were two issues with this.
1) I was sent a questionnaire which effectively was my opinion of lameness grades which can be subjective for a professional and I'm not sure everyone would remember which drugs were used etc.
2) It only asked for outcomes up to a year (I think it did 6,9 and 12 months) My horse was effectively lame for 18 months but then taken barefoot and came sound. Another horse was turned away for 6 months and then remedially shod. At the 12 months stage he would technically have been sound though not in full work and subsequently went lame again. Neither horse had the 'true' outcome represented as the timescales were very short.

2) A phone survey where I was called by a hospital that had treated my horse for allergies. Again it was dependent on my memory and even worse as I was put on the spot to remember things rather than taking my time.
 
Thanks for the responses. It isn't just me then who wonders how vets can give owners a true perspective on whether a treatment might work. And asking owners to assess lameness is ridiculous. I have known people ride their horses for years with obvious lameness issues and they are oblivious. If you point it out they say something like "oh he's just a bit stiff. It wears off when he warms up". Erm... no it doesn't!
 
I think most of the figures come from horses who have been followed through on studies from vet hospitals when the treatments where developed .
 
teddypops said:
Would they not assume that your horse had recovered if you don't contact them to make a follow up appointment?
Click to expand...

They shouldn't do. If the treatment was a last ditch attempt to mend the horse, and it doesn't work, many owners would just retire or PTS the horse. No need to have another trip to the hospital or take the time to phone and get to speak to the consultant who did the op.
 
Another thing to add is I was also told that when doing these follow up surveys (both the ones I mentioned were done by veterinary hospitals) , there is a fairly poor response so that could affect figures if the non response is not spread evenly across different outcomes but is more concentrated on successes/failures.
 
criso said:
Another thing to add is I was also told that when doing these follow up surveys (both the ones I mentioned were done by veterinary hospitals) , there is a fairly poor response so that could affect figures if the non response is not spread evenly across different outcomes but is more concentrated on successes/failures.
Click to expand...

That's a good point. Are people more likely to respond if the treatment failed, because they want to express their dissatisfaction, or are people more likely to respond if the treatment was a success and they are therefore delighted and very pleased to give their time to help with feedback?
 
I asked my vet what the evidence was for efficacy of oil via stomach tube in an impacted colic. She looked at me as if I were mad. Vets are a bit like doctors sometimes, they don't necessarily work as scientists i.e. from evidence rather than from tradition. It's a shame, but presumably they just don't have time to do lots of follow-up work and analysis of data. Perhaps some nice projects there for all our final year equine students?
 
I have tended to make sure that my vet knows the outcomes, he hasn't been my vet for a couple of years since we moved but I think it's important that he knows that 1) Frank's willy cancer has not made a recurrence after somewhat experimental treatment. and 2) he has been completely sound since I took his shoes off (he said he had no case studies with his diagnosis so didn't know before we started).
 
Goldenstar said:
If they did that they are a bit deluded about how the world works for many horses .
Click to expand...

Speedyfluff said:
They shouldn't do. If the treatment was a last ditch attempt to mend the horse, and it doesn't work, many owners would just retire or PTS the horse. No need to have another trip to the hospital or take the time to phone and get to speak to the consultant who did the op.
Click to expand...

Really? As the owner, surely it's up to you to keep vet informed, make follow up appointments. I do!
 
teddypops said:
Really? As the owner, surely it's up to you to keep vet informed, make follow up appointments. I do!
Click to expand...

I actually took the initiative and phoned the specialist concerned on each occasion to let them know that it had not worked. I also gave them regular updates when things were progressing well. However, each time they sounded surprised that I had bothered which to me indicates it is not a common occurrence. And surely, it should be done by the vets themselves, not be up to the owners.
 
teddypops said:
Really? As the owner, surely it's up to you to keep vet informed, make follow up appointments. I do!
Click to expand...

Firstly it may not be your own vets anyway but a hospital and there is no guarantee that your vet would feed back results to the hospital, Also some things are a bit more informal with no cut and dried treatment.

Of the two studies I mentioned, the foot one I went to another hospital for an MRI as at the time mine didn't have an MRI machine. They sent a report and some treatment suggestions but from then on it was managed between myself and my own vet. So when they ask me to reply to a study following up outcomes of MRIs they had no knowledge of what had happened.

For the allergy thing, technically that was the same organisation as it's the RVC but there is some separation with the equine practice and hospital. As there were too many triggers, there was no veterinary treatment possible so it was left to me to manage environment and trigger factors. I sorted it by moving areas and avoiding some key triggers. It's now something that I might mention to my practice vet in passing at vaccination time along the lines of "do you remember how he used to come out in lumps" but there's no formal follow up or even anything that went on his records.
 
Andalucian said:
Quite right, sometimes there is no follow up visit, so how do they know the outcome?
Click to expand...

When my pony had surgery. the surgeon asked specifically if I would let her know the final outcome as recovery times are so long that she rarely got feedback. It was nearly 18 months after the original surgery before we had a "final" outcome so it isn't surprising it is difficult to gain statistics. I suspect it is fairly rare for an owner to contact them, unless the outcome is unsatisfactory.
 
Smogul said:
When my pony had surgery. the surgeon asked specifically if I would let her know the final outcome as recovery times are so long that she rarely got feedback. It was nearly 18 months after the original surgery before we had a "final" outcome so it isn't surprising it is difficult to gain statistics. I suspect it is fairly rare for an owner to contact them, unless the outcome is unsatisfactory.
Click to expand...

I've never even been asked for feedback, so it is good that your vet cared enough to ask. However, the fact that she said that she rarely gets feedback only serves to illustrate my initial point; that the answers vets give regarding the success of certain treatments are most probably guesstimates.
 
criso said:
Firstly it may not be your own vets anyway but a hospital and there is no guarantee that your vet would feed back results to the hospital, Also some things are a bit more informal with no cut and dried treatment.
Click to expand...

Thats where Many people differ. My vets ARE the hospital and do regularly phone for updates. I've just phoned for Lennys 3 month reeval after his OA diagnosis and the vets were fab and encouraged me to call even for slight niggles. They also encourage me to keep them updated and in the loop should I try anything like supliments or massage etc.
My horse has had a massive improvement from where he was, he was totaly unable to pick up either hind foot, unwilling to load, lame on both hind legs, couldnt bend through his mid section. 8 weeks after injections into his spine and a hefty dose of tildren he is now picking both hind legs up with ease can bend through his middle and is only lame on one leg now. So not a total cure but much much better than it was and only 8 weeks into treatment.
 
One of the equine hospitals I worked at kept a diary of all ops, name, client, op, length of surgery, immediate outcome, date of discharge and then updates at 6mths and 12mths. We rang for the updates.
 
Speedyfluff said:
Having had decades of experience of having horses treated by veterinary hospitals, as well as many horses I have worked with, one of the most often asked questions from owners is "What chance does my horse have of returning to full fitness?" or "What percentage success rate does this operation/treatment have?" And vets invariably have an answer for you, often a statistic. However, how do we know these are bonafide figures? I have been to several hospitals on many occasions, and also used several veterinary practices. Not once has the hospital ever rung me, or an owner to check if the treatment has actually worked. So where do they get their figures from? Are they just happy to take our money and tell us any old rubbish, just to make us feel better? If I were a vet, I would WANT to know whether a treatment has worked and ask for feedback a year down the line on any animal I had treated. Why doesn't this seem to happen?
Click to expand...

A lot of work is done under the term of research. So they will take a group of horses, do certain procedures on them and then when they have their results they are destroyed.
 
Speedyfluff said:
That seems a bit drastic. Even if they succeed, they are destroyed?
Click to expand...

I'm no expert but I've stumbled across research papers published on the net for various procedures in relation to horses that I have been interested in reading about and they take a group of animals and when the research has been completed they are euthanised. I have often seen this on the bottom of the paper. I am presuming these are horses used specifically for this purpose, not your run of the mill 'pet horses'. THis is how research is carried out generally as far as I'm aware.
 
Last edited by a moderator:
I guess it depends on the type of procedure and nature of the condition. Papers I've seen on lameness studies talk about horses returning to full work or competitive career or only being used for light work/hacking when discussing outcomes.
 
applecart14 said:
There are also a lot of pointless testing carried out on animals that we probably no very little about.
Click to expand...

Sorry, but this is rubbish. Testing on animals is very expensive and very, very tightly controlled. There may be some that turns out to be pointless but only because of things like the drug not working as expected, which is the point of the testing in the first place. Animals in experiments are covered by both the Animal Health and Welfare Act AND the Animals (Scientific Procedures) Act.
 
Maybe and much of it for non animal related subjects but human but not relevant here.

The question here is when your vet talks about poor prognoses or a 70% change of recovery what are those figures based on.

And none of this is carried out under anywhere near ideal conditions.

Say you had a new treatment for a specific tendon injury. Ideally you would have a reasonable study size that you would follow through with a control group to compare. Because owners can take their business elsewhere, those who can afford it will push for this 'latest' treatment before it has been shown to be of any value so your control group may vote with their feet. Then these injuries can take months to heal and need correct rehab, the majority of the care won't be in a controlled environment but at home with differing facilities and experience.
 
soloequestrian said:
Sorry, but this is rubbish. Testing on animals is very expensive and very, very tightly controlled. There may be some that turns out to be pointless but only because of things like the drug not working as expected, which is the point of the testing in the first place. Animals in experiments are covered by both the Animal Health and Welfare Act AND the Animals (Scientific Procedures) Act.
Click to expand...

To be fair we are going off the topic a bit here but in answer to soloequestrians comment I believe experiments on animals for product testing does still take place especially in Europe where laws are not so tight.

http://www.peta.org.uk/issues/animals-not-experiment-on/

From the above link:

An animal dies in a European laboratory every three seconds. In scientific experiments, animals may legally be poisoned; deprived of food, water or sleep; subjected to skin or eye irritants; subjected to psychological distress; deliberately infected with diseases; subjected to brain damage; paralysed; surgically mutilated; irradiated; burned; gassed; force-fed; electrocuted; and killed. This happens to millions of animals every year.


http://www.bbc.co.uk/ethics/animals/using/facts.shtml
I quote from the above link


Basic facts
•2.73 million experiments in the 12 months of 2002
•Total number of procedures rose by 4.2% on 2001
•About 80% are for research and drug development
•Safety testing accounts for most of the rest

NB: These figures are not complete and take no account of 'wasted' animals - animals bred for their tissues and then discarded or animals rejected because their genetic modifications did not work.
 
Last edited by a moderator:
criso said:
The question here is when your vet talks about poor prognoses or a 70% change of recovery what are those figures based on.

QUOTE]

Presumably from the same sort of research papers that have been written on line that I have read. And from statistics that they have heard from any courses they have had to attend, or any information that is sent to them by research institutions. And from their own experience if they are a large practice.
Click to expand...
 
You must log in or register to reply here.
Top