Monday, May 10, 2010

Decisions, vets and leg injuries

By Terri Rocovich

OK so I know that is quite a disjointed title (not unlike my life at the moment) but I could not come up with anything more eloquent. The purpose of today’s blog is to complain a little, ask for advice – a lot-, and declare the advanced state of vet medicine both a blessing and a curse.

Led injuries in performance horses are not just common; they are inevitable most of the time. Even with diligent, careful care, conditioning and training; jumpers and dressage horses often endure periods in their careers when they are rehabilitating from one sort of a leg injury or the other. The good news in all of this is that veterinary medicine in the past 10 years has taken great strides in diagnostic and treatment modalities. The bad news is that they come with a significant price tag and often vets can’t always agree as to what treatment to choose.

I, at the moment, am caught up in such a conundrum. My beloved little rescue horse Hank (who I was hoping would make it to the upper levels of Eventing) has apparently strained a suspensory ligament. As I have been told by many vets over the years, the suspensory ligament is the nemesis of the performance horse. It is one of the most common, one of the hardest to heal and the hardest to protect against a reoccurrence. So now to my dilemma; although the ultrasound clearly shows a strain and disruption of fibers in the ligament (but no core legion), after consulting 4 vets as to the best treatments options, I have received essentially 4 different opinions.

The first vet and the one who did the ultrasound; she recommended that we do the veterinary equivalent of throwing the kitchen sink at the injury. The kitchen sink entails harvested Stem cells, Platelet Rich Plasma (PRP), and grown stem cells injected at a later time. All of these wonderful veterinary advances come at the price of about $3 – 4,000. The second vet feels that since there is no core legion (actual tear or hole in the ligament) that stem cell injections are not indicated and she recommends shock wave treatments – a less expensive alternative at about $1,500. Vet #3 voted for harvested and grown stem cells but no PRP and vet #4 almost agreed with vet #2 but recommended that we do a contrast MRI to confirm the diagnosis since Hank did not go completely sound with blocking.

Confused? Yea, me too! So I am throwing it out to the universe. What experiences have you all had; good and bad. I want to do right my this horse; not only because I still think he has a promising career but also because I love him and want to give him every opportunity for life to get back to normal. Hank really likes his job and it breaks my heart every morning when I go to the barn and he looks at me as if to say “why aren’t you riding me any more??” He stands in his stall and watches me get the other horses out with the most perplexed sad look on his face. I am still giving him as much attention as I can, but he is still depressed and I can’t even begin to tell you how much I miss riding him.

I know that in time (probably a year) we will be back in the saddle; but I am scared of making the wrong decision as to the best course of treatment now. So I would appreciate any input and advice you all may have and any alternative or additional treatments that I have not thought of. Thanks to all!

6 comments:

Kate said...

My mare had a rear suspensory injury a number of years ago and we did it the old fashioned way - wrapping, stall rest and then ultimately hand walking, etc. It took a long time - almost 9 months - and ultimately she was completely sound and has remained so.

I'd ask the vets what studies have been done. From what I remember of reading the magazines, shock therapy may have some clinical support, PRP and stem cells less so - there's a lot of info on line about what trials have and have not been done. Some of the invasive treatments do have potential side effects. Find out how many treatments of each kind each vet has done - no learning at your expense!

Good luck!

Enjay said...

Since 3 out of the 4 vets recommended stem cell treatment, and additional tests are not a bad thing, I'd go with vet #4.

Laura Crum said...

Oh Terri--I am so sorry to hear this. My heart really goes out to you--Hank clearly means a great deal to you and not being able to ride him at this point in his career is really a tough one, I know. I second all you said about performance horses and suspensory injuries. I have known many rope horses that had to be retired from roping because of this. The most recent one I knew, Harley, who belonged to my uncle, after two years (and all the treatments you've talked about) is now riding horse sound, but is not going back to being a rope horse (he reinjured the suspensory twice when this was attempted). I can only say that my uncle felt that the money he put into those treatments was wasted. In the end, rest, hand walking, slow legging up--done by the family I gave him to, returned Harley to sound, and he is now a trail horse. I guess I'd think long before spending the money on the treatments, based on my experiences with this. I feel for both you and Hank. Poor guy--I know that sad look exactly. I sure hope he makes a smooth recovery. Good wishes to you.

Gayle Carline said...

Terri - I feel your pain. My gelding was on his way to being a superb showhorse (AQHA Trail) when he broke a left rear sesmoid bone. Once the bone was healed but he was still lame, I went through the multiple doctors, multiple diagnoses, multiple treatment options nightmare. The only advice I can offer is to work with the vet you have the best rapport with and trust the most. That's what I ended up doing. I had chronicled Snoopy's injury and rehabilitation in a blog (http://thatsmysnoopy.blogspot.com) and finally found a vet who not only was willing to work with us long-term to find a solution, offered a variety of options in terms of "first we can try this, then ramp up to that", and actually read my blog before our initial conversation. It might be 9 months before your horse is back in business (it took Snoopy about 1-1/2 years) no matter what treatment, but working with an experienced vet toward a common goal will give you the peace of mind you need while your horse is mending.

Laura Crum said...

Terri--I've been thinking of your horse all day, trying to come up with something helpful. The one thing I can offer is that my ancient retired gelding, ET, tweaked himself in the pasture a couple of years ago and had a swollen leg. He was quite lame. A friend who is also a vet did the shock wave treatment on him, and that leg healed up faster than I ever imagined it could. The horse was fine in two weeks--I had been expecting two months if I was lucky. I did not have a diagnosis other than "tweaked" because I was reluctant to spend a lot of money on a horse who is near the end of his road. The vet did the shock therapy on the cheap, knowing the situation. So the injury could have been something vastly different. But it was a soft tissue injury, and it sure healed amazingly fast. It makes me inclined to try that treatment again.

Breathe said...

I'd get the second test first to confirm the diagnosis. If blocking didn't work that may be an indication you're headed down the wrong road.

I'd also look at doing some other fun mental training with Hank - clicker or something, to help him battle stalldom (horsey boredom)