Thoughts on seeking 2nd opinion?

[luise]

My horse is currently in the midst of a lameness workup. I don't want to get into details here, but basically I think it's sacroiliac, which the vet poo-pooed when I suggested that 6 weeks ago because the chiro (who is also a vet) thought his sacroiliac (and hocks) were sore. After a low lyme titer, 2 weeks of Doxy, hock and coffin injections, he is still just as lame, if not more so than when I first called the vet out last month. Next week he is getting a bone scan. I think the vet is leaning towards winter rest and then injections before bringing him back if it is SI. I'm not sure I agree with this if there is just inflammation, and no accute injury.

I am thinking about getting a 2nd opinion. My vet is good, but I am getting very frustrated with him because I feel he doesn't always listen to the history and doesn't like when I question him. Now, I'm no vet, but I am an MD, and so I try to do as research as possible about what could be going on with my horse and what the treatments would be.

Anyway, the vet I am interested in talking to is several states away, and I am unable to take the horse there. Has anyone had a vet review the chart, x-rays, scans, maybe a video of the horse, etc, to get another opinion? I did email this vet to see if he would do it, but I was curious if anyone has done this with any success.

[SLW]

Absolutely get the second opinion. Hope the far away vet will be able to evaluate the radiographs, etc though there is no substitute for him/her seeing your horse in person.

[Ghazzu]

I don't see how any reasonable health care professional, human or veterinary, can be offended by the desire of the affected individual to seek a second opinion.

The only ones who get to me are the ones who keep looking until they find someone who agrees with what they've already decided is wrong.
I just wish them well, and shake my head.

[luise]

Thanks for the replies so far. I'm not really worred about offending my current vet--don't think that would offend him. I think it's just that I'm losing faith in him because he said, "well, it seems like rest worked, so maybe that's what the horse needs." And I feel like my observations and the history are really instrumental in making a diagnosis, and I feel like he blows them off, and only wants to rely on what he sees. The horse had 2 weeks off -- basically from the time the Lyme titer came back at a level much much lower than he thought it would be to getting his hocks and coffins done and bringing him back. Within a week of working the horse after the injections (and at that point it was two weeks from when the injections were done), he was back to where he started.

I didn't want to get too into what's been going on, but I guess I will in brief:
This started 2 months ago, and I can pinpoint the day. Basically he had been going pretty well. I rode him one evening after work and turned him out when I was done. The next day I had a lesson, and from that day on he went down hill. (I wonder if he hurt himself overnight.) He flexes positively everywhere, although the left hind is the greatest. Left stifle x-ray was normal. Left hock xray from PPE in 3/09 showed mild changes in the lower joint.
These are the symptoms:
-the big one is not wanting to work on the bit. Originally it was just at the trot, (not sure about canter because we haven't done much cantering once he started acting this way), now even at the walk.
-will walk and trot a little on the buckle.
-when you try to get him on the bit at the walk and ask him to trot, he would rather try to canter. Or when trotting on a loose rein and then would shorten the reins and ask him to go on the bit, he would either stop/plant his feet, or try to canter. He was normally quite happy to go forward and never pinned his ears. now he pins his ears when you ask him. He is clearly hurting.
-if he does go on the bit, takes very tiny steps, not using hind end at all
-no problem going forward on the lunge line. no ear pinning, etc. stretches down nicely.
-kicks out, explosive buck at the canter when tracking right
-sinks away from pressure applied around sacrum, left greater than right
-trots around paddock no problem


Now, the one thing is I found out that the previous owner did not disclose a diagnosis of kissing spine made 2 years ago (that's a whole other story). Although neither the vet nor the chiro could elicit any tenderness/pain from where the KS is. Maybe that is part of the problem, I don't know, but we'll find out on the bone scan.
I am just so frustrated that I am really thinking about getting a 2nd opinion. The other vet I want to use is very well know and a good 6-7 hrs away, so I would only be able to provide records, and maybe make a video of how he is going now.

[BuddyRoo]

I'm sure you've dealt with this in human medicine...but with my background in veterinary medicine I just feel like it should be said...if you DO go for a 2nd opinion, don't offer everything you know.

Tell the new vet that you're here for a second opinion and you will answer all questions to the best of your ability/provide diagnostic results but don't want to muddy the waters with everything you've done/observed thus far. Let THEM find the path.

Sometimes, a fresh pair of eyes and a fresh perspective will get to the root cause more quickly without the muddying of waters.

We ran into that a lot at the clinic when we did 2nd opinions. It's almost easier to begin at the beginning with the workup than to use old and possibly outdated information or observations that sometimes lead you down the wrong path and into a jungle.

Good luck!

[FatPalomino]

I defiantly agree with Buddy Roo. Ask the vet to look at the horse and later, provide the history n a 2nd opinion and listen to what the 2nd vet's thinking, too. The horse should be able to help ID the source of pain. Good luck.

[NorCalDressage]

I think the bone scan is a good idea. Especially is you're suspecting KS.

Then send the all of the information for a second opinion. Your vet should not be offended. Our horses are very important to us and sometimes we just NEED to make sure the correct decision is being made, you know? Don't feel bad about that!

[LuckOfTheIrish]

I am going through something similar with my mare and I am also getting a second opinion. I, too, feel as though my current vet is not taking the horse's history into account, and am looking forward to a new perspective from fresh eyes. Good luck!

[Delaware TB]

I second the bone scan idea, and I don't think your vet would be upset about it at all.

[Dressage.For.Life.]

Yes, get the second opinion!

I'm dealing with some mysterious lameness issues with my horse and my regular vet referred me onto Purdue or ideally, Rood & Riddle. Keep in mind that I'd have to get a working friend to haul my horse the 4 hours to Lexington.

I decided to first send his hock x-rays to Rood & Riddle and Dr. H. reviewed them- saying pretty much the complete opposite of what my regular vet said. Currently waiting for the x-rays so I can send them on to Colorado for an x-ray / CT (cunean tendon) consult. I too did lots of research, and I think CT surgery may be the key for my horse- so I'm sending them on to Colorado as Dr. Page is the one who continued to improve the "modern" CT surgery. So if she thinks this could help him, I could have the surgery done for quite possibly cheaper than the diagnostic work Dr. H. said would be the "next step".

It was $150 to have Dr. H. review the x-rays and to do a (very brief) phone conference. It's going to be roughly $60 at the Colorado Equine Clinic.

So definitely, send the x-rays before hand and get the second opinion.

Good luck!!

[luise]

Oh, let me clarify a few things. Horse was diagnosed with kissing spine in the thoracolumbar area 2 years ago on a bone scan. The thing is, this issue he has now almost seems like it happened overnight. And both the vet and the chiro have palpated his spine where the KS supposedly is, and found nothing. But when you palpate around his sacrum, he sinks away from pressure.
No matter what he is getting a bone scan next Wednesday--that's already been decided.
But the issue is I am in CT, and I'll just say it, I wanted Kent Allen to look at the scans, chart, maybe a video of how the horse looks on the lunge and under saddle, and give me opinion about diagnosis (if needed) and management. I don't have my own trailer though, and so can't drive the horse 6 hours to be examined.

Now who knows, maybe on the bone scan the KS will light up and that is causing all of the pain. Then it would be problem solved and I don't think I would seek the 2nd opinion.
But if a bunch of things light up and the vet says turn him out for the winter, well, before that I want a 2nd opinion.

[McVillesMom]

I agree with Ghazzu - if your vet has a problem with you getting a second opinion, you need a new vet. It sounds like that isn't the problem, though - it sounds like he isn't listening to you, the person who knows the horse best. Sometimes owners tend to think something is important when it really isn't, or not notice things that may be very important to a diagnosis, and it can be hard to weed through that to figure out what's really going on; however, he shouldn't dismiss your observations out of hand.

That said, I think getting a consult from Dr. Allen is a great idea. He's going to be a little bit limited by the fact that he can't actually see and palpate the horse, but he's pretty amazing regardless. I spent 2 weeks at his clinic on an externship earlier this summer, and it was unbelievable the subtle things that he (and the other doctors) picked up on. No one can question his credentials, that's for sure!

[Simkie]

My favorite vet SEEKS OUT other vets that she respects to get second opinions on her own. And I love her for it. I think all vets should be so proactive.

ANY vet that is so insecure that he or she doesn't want you to consult someone else shouldn't be your vet. No one can know everything, and everyone can learn something from others.

(In fact, your horse's history sounds a bit similar to Blush. If you'd like my vet to consult, I'd be happy to give you her number. She is WONDERFUL. I also think the bone scan will help pinpoint things. Make sure you use a clinic that uses enough radioactive material to adequately image the pelvis [CSU, for example, does not.] Have you considered gabapentin? It would help you rule out wind up/neuro pain.)

[GotSpots]

These are the symptoms:
-the big one is not wanting to work on the bit. Originally it was just at the trot, (not sure about canter because we haven't done much cantering once he started acting this way), now even at the walk.
-will walk and trot a little on the buckle.
-when you try to get him on the bit at the walk and ask him to trot, he would rather try to canter. Or when trotting on a loose rein and then would shorten the reins and ask him to go on the bit, he would either stop/plant his feet, or try to canter. He was normally quite happy to go forward and never pinned his ears. now he pins his ears when you ask him. He is clearly hurting.
-if he does go on the bit, takes very tiny steps, not using hind end at all
-no problem going forward on the lunge line. no ear pinning, etc. stretches down nicely.
I'm sure you've already ruled this out, but is there any chance he's got your number under tack and is barn sour? I obviously don't mean to beat a lame horse, but if he's going forward comfortably and well on the lunge, I'm a little curious to know if he's figured out that he can stop or make icky faces or kick out at your leg and end up doing much less work under saddle and then will get to go back to his stall. I wouldn't be drilling him - but might be worth having someone pretty experienced get on him and see what happens to at least rule it out, if you've not done so already.

As far as a second opinion goes, it doesn't sound like you really have a first opinion yet! Dr. Allen is certainly as good as it gets, but I do think with that package of symptoms it's hard to tell from a distance. Depending on where you are, you might be able to hop a ride with someone down to M'burg, or else there are other very good diagnosticians up and down the east coast who might be closer to you who could give you some thoughts.

[tpup]

I'm sure you thought of these things, but what about saddle fit since he is better on the lunge line? Ulcers? He sounds alot like my horse who had ulcers - he was just crabby in general about going forward. He was also terribly barn sour. Once we fixed the ulcers his barn sourness improved tremendously.

Also did the vet palpate and check his neck? My horse had pain and stiffness at C3 in his neck on the right. Exhibited similar symptoms regarding not wanting to work on bit - on loose rein his nose was on the ground. I kept thinking back pain but vet found sensitivity in his neck.

I would absolutely get a 2nd opinion - what about Dr. Allen in VA? Not sure if he'll do a long distance consult, but I've heard great things about him.

Good luck!

[luise]

To answer a few questions--the horse has a custom saddle for him that was double checked by my saddle fitter when it came. So tack is definitely not an issue. It fits him perfectly.
Horse is definitely not barn sour. He generally has a great attitude and is very willing to work. He would jump anything you point him at (haven't jumped him since this happened). He tries for you when you ask, but now it is clear that something is hurting. Initially after the 2 weeks off, he went happily forward. granted, it was on the buckle, and only a few strides of self carriage, but still. As I asked him to do more and more work on the bit, he returned to where he was lameness wise. For example, he would trot around on the bit, but the more we did, the more it was obvious then something was hurting--tiny steps behind, slowing down, eventually progressing to just not wanting to move. This is a huge change to how he was April-August, and he just feels different under saddle.

Also, my trainer rode him for the vet yesterday and experienced the same thing. I've been on the horse that is barn sour and not wanting to move, and the feeling is not the same. My horse just physically feels different. I don't think the vet palpated his neck the first time he came out, not sure if he did it yesterday since I wasn't there.
He is clearly sore around the sacrum because he sinks away when you apply pressure there. And last weekend, when he was really not wanting to go, my trainer thought his left hind looked "funky."

I haven't considered ulcers because he doesn't seem to have any of those symptoms. He has a lovely shiny coat, is not girthy, no problems brushing his belly or tacking him up. I wouldn't discount it, but it is at the bottom of my list, especially considering his history.

I know I need to get the first opinion, but I like to plan ahead. If my vet says give him the winter off, I want someone else to give me an opinion too. Because depending on how many months that could be, that may change a lot of things for me. I think it is either the kissing spine, SI, or some combination, because in both cases horses tend to move fine on the lunge, but not under saddle.

Anyone going to Middleburg from CT? I don't have the time work-wise either to go down there, but I would happily let him hitch a ride with someone!

[JustJump]

How old is this horse?

You say he was 'better' after rest, yet you opted to inject him.

Was there something specific you were hoping to address with that procedure?

How steady was/is this horse's work/exercise schedule? If you are in CT and the horse is in MD, how is it you are able to keep close tabs on the situation at all?

How long ago was the saddle fitted How good was the fitter? Has the horse's wieght/level of fitness changed since? (It's easier to change pads than a saddle, so other than tree width, I'm not inclined to go overboard customizing saddles to horses beyond reasonable parameters).

K.A. is a great vet, but if you are in MD, there are many closer options for complete workups--if he's your guy, why not ask him for a referral to another vet/clinic?

Turnout is not a bad idea when you are mystified.

[luise]

How old is this horse?

You say he was 'better' after rest, yet you opted to inject him.

Was there something specific you were hoping to address with that procedure?

How steady was/is this horse's work/exercise schedule? If you are in CT and the horse is in MD, how is it you are able to keep close tabs on the situation at all?

How long ago was the saddle fitted How good was the fitter? Has the horse's wieght/level of fitness changed since? (It's easier to change pads than a saddle, so other than tree width, I'm not inclined to go overboard customizing saddles to horses beyond reasonable parameters).

K.A. is a great vet, but if you are in MD, there are many closer options for complete workups--if he's your guy, why not ask him for a referral to another vet/clinic?

Turnout is not a bad idea when you are mystified.

Ugh, please read all the posts. Horse is 7 years old I have no idea where you got the idea that the horse is in MD. WE are in CT. The "better" after rest was in retrospect. Horse was injected because the Lyme titer was not as high as we expected it would be. Horse got 1 week of rest after the titer came back (I chose not to work him because it was clear the lameness was not because of Lyme), and it was another week before he got injected. Thus, the 2 weeks. So when he seemed better, we thought it was maybe because of the injections, but since then it was 2 weeks went by and he was really no better when back in work, the vet thought he maybe seemed better because of rest. If that makes sense. The vet is the one who suggested injecting him.

the saddle fitter is excellent. She is highly regarded here and gets many positive reviews on this board. The saddle arrived early August. Saddle fitter came out 8/4 and readjusted the saddle/flocking for him. His weight has not changed and he was in regular work. Trust me, saddle fit is NOT the issue. Both the vet and chiro have also looked at it and the saddle fits beautifully. Plus, he was being ridden in the dressage saddle which also fits him very well. The horse had been in regular work. One day he was fine, the next day he wasn't.

Anyway, the main question is has any sought a 2nd opinion without the vet actually examining the horse, i.e. a chart review, review of scans, etc?