When to stop vet treatment?

[Jo C]

Opinions please.
My Connemara ovenight developed a bony lump in the splint area of his left leg back in Dec 05, this was diagnosed by my vet as a bone infection due to the way the bone looked under xray, he received antibiotics (also developed laminitis when on box rest which complicated things slightly) and was brought back into work, the lump continued to grow so another course of antibiotics was prescribed. In April the lump was so large it was starting to press on the tendon so the decision was made to operate to remove the splint bone and the lump, followed by another course of antibiotics. The operation was a success, my pony had around 8 -9 weeks off and was brought back into work on the advice of my vet. Unfortuntely the lump then started to grow back, an intensive course of 2 different antibiotics was started. This has made no difference and the lump is now back to the size it was before the operation. My problem now is that my vet wants to refer me to a specialist who has suggested we operate again, however added to the problem is that I have already gone over my £5k vet fees limit on my insurance.
As awful as this sounds I do not have the money to keep trying to sort this, but I don't know where you draw the line. How do you stand with the insurance company if you cannot afford to keep going with the treatment? What would everyone else do? I would like to point out that the pony is currently sound but with the growth rate of the lump I don't think this will be the case much longer.
I'm sorry for the long post and well done if you have made it this far.
I have tried to leave my emotions out of this so I'm sorry if the post sounds a bit cold and hard hearted its just my way of dealing with it atm.

 

[AmyMay]

Well, as far as the insurance issue goes - that's quite simple. Once you have reached the limit - end of story. All future costs are down to you.

With regards the pony. I think that there are a number of questions to ask when you see your consultant next week.

No 1. What do they actually think the growth is?
No 2. What course of treatment other than surgery could be a possiblity? (as surgery doesn't seem to have fixed the problem long term)
No. 3. What do they consider the actual prognosis to be?

Personally I would want to know the answers to these questions before I made any decision on how to proceed.

 

[ihatework]

I don't think you are cold hearted at all, a tricky situation to be in and I'm not sure how I would proceed if I were in your position.

How old is the pony? Is the pony specifically for competition purposes?

I'm struggling to understand exactly what the lump is ...

presumably (and forgive my ignorance) if the vet diagnosed it as a splint and xrays indicated it was originating from the splint bone (hence the subsequent removal) then I would not have expected it to reform. Have the vets given you any further indication about what the lump is and why it is forming again?

 

[Jo C]

[ QUOTE ]


With regards the pony. I think that there are a number of questions to ask when you see your consultant next week.

No 1. What do they actually think the growth is? They now think it is a severe reaction to the operation ie the body is protecting itself by laying down more bone. Although I get the impression that they really are not sure to be honest.
No 2. What course of treatment other than surgery could be a possiblity? (as surgery doesn't seem to have fixed the problem long term)
No. 3. What do they consider the actual prognosis to be?

Personally I would want to know the answers to these questions before I made any decision on how to proceed.

[/ QUOTE ]

I agree however I don't think that any treatment they have so far suggested (including firing, freezing and blistering as well as operating) is likely to work as these are all invasive procedures likely to cause the body to produce this over aggressive reaction already seen. I guess I am really looking for assurance that I am doing the right things here.

 

[AmyMay]

[ QUOTE ]
I guess I am really looking for assurance that I am doing the right things here.

[/ QUOTE ]

I think really, you are possibly looking for someone to confirm what you are already thinking - which is stop treatment now, see how it goes, put pony down.

That's a judgement call only you can make I'm afraid.

 

[Jo C]

[ QUOTE ]
I don't think you are cold hearted at all, a tricky situation to be in and I'm not sure how I would proceed if I were in your position.

How old is the pony? He is 13
Is the pony specifically for competition purposes? He was a show pony but also competes in dressage.

I'm struggling to understand exactly what the lump is ... (You are not the only one!)

presumably (and forgive my ignorance) if the vet diagnosed it as a splint and xrays indicated it was originating from the splint bone (hence the subsequent removal) then I would not have expected it to reform. Have the vets given you any further indication about what the lump is and why it is forming again?

[/ QUOTE ]

It seems that it was an infection of the bone in the splint area, the body's defence mechanism to the infection is to lay down more bone to effectively block the infection, however if the infection is not tackled the body will continue to lay down more bone and so on.. The problem initially was that there are not many anitbiotics that can treat bone infections.
Now it seems that because during the operation they had to remove the bone covering (which has a technical name of peri something I can't remember) the body tries to repair itself which usually results in a very small lump in the operation area. However in my pony's case they believe he is showing a very agressive reaction and so has grown all this bone (the lump)as a defence mechanism almost. Therefore I am concerned that any other treatment we try is going to result in the same reaction. Does that all make sense? In which case I am just throwing money away - that sound awful but you know what I mean.

 

[Jo C]

yes Amymay I think you are right, I guess what I need to know is how do you know (if you ever do) that you are making the right decision - and I don't really expect you to answer that but thanks for talkig this through with me - much appreciated.

 

[Sparklet]

Jo - speak to your vet. They understand insurance limits, alternative treatments and the prognosis for cases like yours. None of us (well very few anyway) have money to burn and once the insurance cover is exhausted there does need to be some discussion with your vet about the options open to you. I for one could not carry on with expensive treatments which were unlikely to work - my finances would just not stretch that far.

Your vet is the best person to advise you. Good luck

 

[ihatework]

Yup, sort of makes sense.
I think if it were me I'd look for a referral to a specialist for a second opinion. I'd set aside a specific amount of money I'd be prepared to further spend (say £500 for a specialist review) and after that call it a day ... i.e. not investigate further.

If your pony is currently sound then I'd be inclined to leave it alone.

Just a random thought, but presumably some form of bone tumour has been ruled out ? (not wanting to sound alarmist, and I know b*gger all about veterinary medicine!)

 

[Jo C]

Thank you Sparklet, I have left a message for my vet to phone me to discuss this. The thing I am not sure about is where you stand with the insurance company on this. Will they allow me to have the pony pts if there are possible treatments available athough I can't afford them? I only ask as a friend's 2 year old recently sliced through her tendon sheath, the prognosis was only a 40% chance she would spend the rest of her life in the field, and this was after an intensive operation to repair the sheath and having to spend 9 months in a cast in a stable. My friend opted to have her pts but the insurance company wouldn't pay out her value as there were options to save her life. It would have cost getting on for £10k to do this.

 

[Jo C]

A bone tumour has been mentioned but is thought to be unlikely, I think the consultation next week will possibly look into this.

 

[Maesfen]

I've read all of the replies and think Amymay has knocked the nail on the head - get those questions answered before you make a decision.

Without sounding rude, are your vets horse specialists as this seems to be necessary in this case? If not, could you get a second opinion from vets that are, many will see different things in each case and could have another answer for you (not to say they will but to say it's a possibility).

I don't know your particular circumstances, whether he's kept at livery or at home (which would have a lot of bearing for me) If he's at home, have you the time, money and space (if you can buy another) to keep him on low key maintanance and see how things go for another 6/12 months? If it settles down once fully formed, given time, it might just shrink a little like splints usually do but then again it might not so I wouldn't want to get your hopes up. The other option of course if you are on livery so everything mounts up the pressure, would be to take the decision to put him down before he gets any worse; let's face it, this year of op's and box rest will not have been a picnic for him either and is it fair to put him through it all again anyway; how do you know a second op will make it any better; it could just be putting hard earned money into the vet's pockets at the end of the day with nothing to show for it if it can't be improved?

Only you can make that decision but, no, you are not being cold or heartless, just practical; it is not worth bankrupting yourself/family if the horse is never going to come right. Far better IMO to get the answers to those questions first then make a decision but to my mind it doesn't sound very hopeful after the reaction to the first op'; it could well have been one of those times that the op made it worse (by the rapid regrowth) than if it had been left to time to see how it would have settled without the invasive surgery.
Good luck with next week's consultation; let us know how it goes and I do sympathise truely; it's horrible having to play God.

 

[Jo C]

[ QUOTE ]
I've read all of the replies and think Amymay has knocked the nail on the head - get those questions answered before you make a decision.

Without sounding rude, are your vets horse specialists as this seems to be necessary in this case? If not, could you get a second opinion from vets that are, many will see different things in each case and could have another answer for you (not to say they will but to say it's a possibility).

Yes they are specialist horse vets and to be fair to them have been in consultation with both Ian Wright in Newmarket and an ortho vet at Cambridge all the way through the treatment.

I don't know your particular circumstances, whether he's kept at livery or at home (which would have a lot of bearing for me) If he's at home, have you the time, money and space (if you can buy another) to keep him on low key maintanance and see how things go for another 6/12 months? If it settles down once fully formed, given time, it might just shrink a little like splints usually do but then again it might not so I wouldn't want to get your hopes up. The other option of course if you are on livery so everything mounts up the pressure, would be to take the decision to put him down before he gets any worse; let's face it, this year of op's and box rest will not have been a picnic for him either and is it fair to put him through it all again anyway; how do you know a second op will make it any better; it could just be putting hard earned money into the vet's pockets at the end of the day with nothing to show for it if it can't be improved?
He is on livery, everything you say keeps running through my head, you are so right but having to make a decision is so hard, particulary when he is sound at the moment and to all intents and purposes if you didn't know the history just has a splint on his leg.
Only you can make that decision but, no, you are not being cold or heartless, just practical; it is not worth bankrupting yourself/family if the horse is never going to come right. Far better IMO to get the answers to those questions first then make a decision but to my mind it doesn't sound very hopeful after the reaction to the first op'; it could well have been one of those times that the op made it worse (by the rapid regrowth) than if it had been left to time to see how it would have settled without the invasive surgery.
Good luck with next week's consultation; let us know how it goes and I do sympathise truely; it's horrible having to play God.

[/ QUOTE ]

Thank you - I will let you all know how we get on.

 

[Sparklet]

They are funny things insurance companies and a lot depends on your policy. If you have loss of use it has to be shown that the 'use' you specified he was for is no longer possible. It is difficult and I have known people being refused a loss of use payout because the horse can still walk on a hack.

I think they will pay for euthinasia if the vet recommends it - your vet may give you some idea but perhaps reading the small print in your policy to make sure.

It is a painful decision to make without having to faff about with documents as well. I do feel for you.

 

[brighteyes]

It's really down to finances and quality of life for your Connie. You will know whether he's had enough if that point is reached before the money runs out.

When we buy our ponies, we are making two commitments - to maintain them to the reasonable best of our ability and to see them gently through to the end, if and when that time comes.

You have had some very sound, helpful advice and you seem like a very sensible owner to me. He doesn't know what a lucky pony he is. I wish you well and that your choice soon becomes obvious. We have to be brave and humane on behalf of our equines.

 

[wvfoxylady]

Totally agree with what 'maefenshorse' said above. In my own personal opinion I would ask your vet whether this lump was sent for biopsy?Because if it was you and your vet would know exactly what your dealing with and the prognosis (whether the lump will return? is it malignant/benign.Is it boney tissue or can it/has it spread to soft tissue also ie tendons etc?)What treatments are there?? If it was my horse with this problem I would take the horse for the referral myself,so that the specialist (whoever was providing the relevant info to your usual vet)can see your horse with his own eyes and give his opinion on treatment.Ask for an estimate for consultation before you go. Then if the worst does come and there is no other route of treatment other than further invasive surgery then unfortunately you may have to make that decision but,it may make your mind up for you,because if you still have doubts should I,should'nt I, makes life so much harder.I totally sympathise with you at this time but good luck and let us know.xxx

 

[Louby]

Im so sorry, what an awful position to be in.
Just wanted to add and sorry if its not what you want to hear but I think the insurance wont pay ont for death unless its on humane grounds. I was told of someone whos horse had to retire due to ringbone, navicular etc and she was getting worse but although the insurance paid for all vets fees they wouldnt pay out for death as they said the horse didnt need to be PTS. The poor horse was crippled! If however the horse had a broken leg, they would pay as it needed PTS immediately. I do think a lot depends on the company as my old horse had surgical colic and they let me decide whether to take her for surgery or have her PTS . We were in the process of claiming LOU at the time so I suppose to the insurance having her PTS was cheaper than having surgery but they were absolutely fantastic during my claim.
I really feel for you.

 

[Jo C]

Thank you everyone for your very sound advice, I have had a chat with my vet and decided to take the pony for his consultation but will ask them not to xray or scan unless absolutely essential. I will let you all know how I get on. Thank you all!

 

[dunc_n_toby]

What an awful position to be in, the only info I can give is that last year my horse was diagnosed as a wobbler (Wrongly, thank god!) and when discussing the options with my vet he said that although my lad would eventually deteriorate to the point where he became a danger to himself that the insurers would not pay out if I chose to have him PTS as I would not be doing that on humane grounds! Charmin! Fortunately in my case it was mis diagnosed!

 

[Jo C]

This is basically what my vet has said to me - as long as he can live in a field on bute the insurers will not pay out as it is not considered life threatening. The fact that the poor thing will be crippled is neither here nor there. Talk about loop hole!

 

[Kelly1982]

[ QUOTE ]
This is basically what my vet has said to me - as long as he can live in a field on bute the insurers will not pay out as it is not considered life threatening. The fact that the poor thing will be crippled is neither here nor there. Talk about loop hole!


[/ QUOTE ]

Thats exactly the problem i had when my vets diagnosed my horse with wobblers!! Even though it is a degenerative disease and the horse can cause harm to others as it gets worse they would not pay out as he could still live in the field til the disease took its toll.

Luckily i went for a second opinion from a wobblers specialist and it turned out he had been diagnosed wrong but i know exactly where you are coming from!!

They will only pay out if the horse needs to be put down there and then on the vets advice. bl**dy stupid if you ask me as it makes you wonder why you pay insurance!!