When would you call it a day?

[ChestnutMare13]

I have had my mare for just over 4.5 years. She is a 12 year old chestnut TBx mare. In the time that I have owed her, we have probably had a total of 2.5 years where she has been in full ridden work as she has had a multitude of issues:
- Kissing spine: confirmed via bone scan and x-rays before she had 7 processes reshaped and the ligaments cut under general anaesthesia
- Ulcers: grade 3 glandular and grade 2 squamous confirmed via scoping and treated with Gastrogard, sucralfate and ultimately omeprazole injections over 5+months
- Progressive ethmoid hematoma in the right frontal sinus: confirmed via CT under general anaesthesia and sinoscopy and treated with formalin injections and laser ablation
- Fractured rib: came up on bone scan

Whilst she was successfully rehabbed from the kissing spine, she has recently gone lame in front, particularly her right fore. She had a lameness workup and came largely sound after the palmar digital nerve block although, when lunged on the hard, she appeared slightly lame on the left fore. X-rays revealed arthritic changes in the coffin joint on the right fore and she had steroid injections in both coffin joints but, after 2 weeks, she is still considerably lame in trot. The vets have suggested that the next stage is an MRI.

In addition to that, she has had yellow nasal discharge out of her right nostril for a couple of days which isn't resolving itself (the vet is booked to come and see her in relation to this). One symptom of the progressive ethmoid hematoma was mucopurulent discharge out of her right nostril which only cleared up temporarily with antibiotics. I understand that the prognosis for long-term resolution of progressive ethmoid hematomas, even with appropriate intervention, is considered guarded to poor.

No time, commitment or financial expense has been spared investigating and treating this horse's issues in order to get her pain-free and rideable. Vet fees alone have come in at over £10,000 in trying to sort out her various issues. But, at only 12, she has been through so much and I don't know how much more I am willing to put her through, given that more issues are coming to light.

Essentially, my question is - when would you call it a day?

 

[Alibear]

I've learned that if I'm asking the question about when, the answer is usually now. But it is so much tougher to do in real life. As always, you know the horse and your situation best.

 

[paddi22]

It sounds like you have tried everything you can. The fact there are so many issues would make me consider pts. Some horses just never come right and when issues are progressive and permanent you have to be realistic about what is feasible as an owner money and step wise. I know if I was in your boat I would stop treatment, give her the summer to relax and then pts before winter I think. The only reason I wouldn't is if the lameness had cleared up, and the nasal discharge wasn't a massive issue.

 

[nagblagger]

I'm sorry to hear about your mare. It sounds like you have already gone above and beyond what some owners would have done.
Is she happy and alert, although i agree with Alibear, that once you start questioning this, it is only a matter of time. I think most of us would all support your decision.

 

[ycbm]

I'm afraid it would be time very soon for me. I'm sorry you're in this position after working so hard to get her right.
.

 

[ChestnutMare13]

I'm sorry to hear about your mare. It sounds like you have already gone above and beyond what some owners would have done.
Is she happy and alert, although i agree with Alibear, that once you start questioning this, it is only a matter of time. I think most of us would all support your decision.

Hi nagblagger
She has always been known to have a big personality and to be the ringleader causing trouble in the herd. However, she recently got moved to a new field and, whilst the other herd members went cantering off, she only managed a couple of strides before seemingly giving up. Under normal circumstances, she would be the last one to calm down and would be encouraging the others to prat about so I am noticing changes in her behaviour now so she is clearly in a fair bit of pain. This was 2 weeks after the steroid injections also.

 

[nagblagger]

You are attuned to her differing behaviour which obviously shows she is not a happy horse, (many owners would ignore this or not notice!) discuss with your vet but i feel she is in discomfort. Being a conscientious owner you will do the right thing.
sending a virtual hug

 

[Barton Bounty]

sadly I think you are answering your own question, you have done everything you can for your girl For you it seems like one thing after another and if I was in that position it would be now

 

[AmyMay]

Given her history, the minute she went lane again it would have been an adios from me.

 

[Pearlsasinger]

I always like to think that I am prioritising quality of life, so if she can't/doesn't want to keep up with the herd, I would be thinking very seriously about pts.

 

[EllenJay]

I think as soon as you ask the question, the time has come. Best wishes xx

 

[Peregrine Falcon]

She's had a lot going on the past 4.5yrs. When you start thinking about quality of life then it's time. I appreciate that it's hard as she's just 12, I know how difficult it is having made that decision for my beautiful homebred 12yo recently.

 

[Zoeypxo]

Sorry to hear about your horse. If it helps, steroid didnt work in my horses coffin joint arthritis but arthramid has been excellent and 100% sound back in work.
What does your vet think?

 

[Red-1]

I would pick an appropriate day and PTS, if she were mine.

 

[ChestnutMare13]

Vet came out today in respect of the nasal discharge and thinks it is sinusitis caused by the return of the ethmoid hematoma. Antibiotics and pain relief have been prescribed but I was warned that it could come back after the course is finished and I have to consider whether to put her through more sinoscopies etc. The vet thinks that I should have an MRI done regarding the lameness so that I’ve got a full picture.

 

[TPO]

Vet came out today in respect of the nasal discharge and thinks it is sinusitis caused by the return of the ethmoid hematoma. Antibiotics and pain relief have been prescribed but I was warned that it could come back after the course is finished and I have to consider whether to put her through more sinoscopies etc. The vet thinks that I should have an MRI done regarding the lameness so that I’ve got a full picture.

An MRI to what end? It's an (expensive) diagnostic tool. What's the best outcome of a diagnosis? Then look at the treatment for that.

Your mare has so much going on already and you've really been through the mill together.

I'd already have called time tbh. Sorry that you're in this position

 

[ChestnutMare13]

An MRI to what end? It's an (expensive) diagnostic tool. What's the best outcome of a diagnosis? Then look at the treatment for that.

Your mare has so much going on already and you've really been through the mill together.

I'd already have called time tbh. Sorry that you're in this position

Hi TPO
At this point, I am not sure whether they consider it’s an MRI for my peace of mind that there really is nothing more that can be done, rather than from a diagnostic and treatment perspective.

The thought has crossed my mind, given that she has been unresponsive to steroid injections, that there could be an additional cause for / contributing factor to the lameness other than the arthritic changes in the coffin joint already found, such as a soft tissue related problem.

 

[TPO]

Hi TPO
At this point, I am not sure whether they consider it’s an MRI for my peace of mind that there really is nothing more that can be done, rather than from a diagnostic and treatment perspective.

The thought has crossed my mind, given that she has been unresponsive to steroid injections, that there could be an additional cause for / contributing factor to the lameness other than the arthritic changes in the coffin joint already found, such as a soft tissue related problem.

Obviously your decision. I now have the benefit of hindsight and I wish I'd just called it sooner. Not so much for the horses welfare, he never suffered, but for me. Until he was gone I didn't realise the daily stress of caring for a broken horse for years.

Like at some point there has to be a line and thsts for the to call.

If she has an mri and they find something will you then feel obligated to try, I dunno, further injections, stem cell, more Bix rest etc

It's a horrible position and you have my sympathy

Having travelled the hard path many (many) times I would make the call earlier if there was a list of things again. I was almost 6yrs and 36k in on trying "one last thing" numerous times...

 

[nagblagger]

Would you be able to PTS without later thinking 'what if?'
Would you feel guilty for not making the decision sooner ?
Is she suffering, is there a chance of a cure?
Can i afford it? (controversial but realistic)

Those are the questions i ask myself , but I am now a 'too early is better than a day too late' person, through experiences.

 

[Trouper]

The MRI may or may not reveal something else. The question for me would be "Is what I am dealing with now - in front of me - capable of being resolved to return her to a happy, healthy horse for the forseeable?" If the answer is "no" then I would pts now.

I have been at that tipping point twice where you have to decide how much further to go and it is horrible. In both cases I got second opinions which helped me to make the final decision to pts in the best interests of the horse. That was the only consolation.

 

[Errin Paddywack]

I was offered a CT scan on a dog with suspected throat cancer. I asked what difference it would make to prognosis/treatment. Answer 'none'. Didn't waste my money and that dog was my dog of a lifetime. Your horse has so many different problems, none easily resolved, personally I wouldn't throw any more money at it. PTS would give both of you peace.

 

[alibali]

I certainly wouldn't MRI for the lameness until I saw whether or not the sinus issue returned after antibiotics. Even if the sinus problem resolves I still wouldn't MRI unless I got a clear answer as to what value it would add to treatment.

To be honest pts is a difficult call to make at the best of times and not always clear cut however you are the best placed person to assess horses quality of life and also your own finances and emotional reserves to carry on. I would suggest that pts on any of those grounds could may be justified but only you can truly evaluate the circumstances. Not an easy place to be, having been there previously myself you have my full sympathy.

 

[Ratface]

I'm really sorry that you and your horse are going through this.
In your position, I would plan to have her quietly pts in the near future.
I think that you have gone above and beyond most people's capacity to absorb the emotional, financial and practical problems that you have already achieved in your search for a remission or cure for her serial states of ill health. Do you really think that further interventions of any sort will help her become even field sound and content with her life?
I'm in the "week too early, rather than a day too late" camp. I think she would be more comfortable now, and in the future if she was, as soon as possible, quietly pts.

 

[ChestnutMare13]

To update you all, the sinusitis cleared up following a course of antibiotics. In respect of the lameness, she got progressively worse despite not being in work. As the sinusitis had cleared up, I went ahead with the MRI which confirmed arthritic changes in the pastern joint, not the coffin joint as had been diagnosed from the X-rays done previously. All the other structures in the feet looked great. She’s had steroid injections in the pastern joint and some corrective shoeing to assist with hoof balance has been prescribed but the vets are confident that the condition will be effectively managed with this combination.

 

[Birker2020]

To update you all, the sinusitis cleared up following a course of antibiotics. In respect of the lameness, she got progressively worse despite not being in work. As the sinusitis had cleared up, I went ahead with the MRI which confirmed arthritic changes in the pastern joint, not the coffin joint as had been diagnosed from the X-rays done previously. All the other structures in the feet looked great. She’s had steroid injections in the pastern joint and some corrective shoeing to assist with hoof balance has been prescribed but the vets are confident that the condition will be effectively managed with this combination.

That's brilliant news. Glad you kept her going long enough to have the MRI. What a nightmare for you.

I do hope you have a successful outcome and you have many years of somewhat delayed fun together x