Vets and diagnositcs

[OceansAway]

So it seems my horse has a pulled hamstring muscle, per the vet. He said that she is sound for walking and light trot work and to keep her on Robaxin during this time. The vet said if she is not improved, then she might need her SI injected as the surrounding muscles and ligament are attached to the area that seems most painful. Instead of trying something, waiting, trying something different, and waiting again, why don't vets go right to heavier diagnostics? Is this just typical? I am just concerned about letting it go for that long, in case it's some sort of ligament injury, or just something more severe in general. I will call the vet Monday to discuss but I wanted to see if people had another angle or reasoning on this matter because of course I will have this on my mind until then. Thanks!

[BuddyRoo]

I honestly think it's because most CLIENTS refuse such diagnostics.

IF that's what you want to do, ask for it.

[MunchkinsMom]

I have first hand experience with pulled hamstrings in horses. My mare pulled her left hamstring when she was 20. My vet did not say anything about injections, so perhaps this is a new protocol for treatment?

At any rate, what I did was stall rest, restricted turnout (small paddock), hand walking for 20 minutes every day, and alternating heat and ice packs. For heat, I would put on one of those heat up pads from the drugstore, that are designed to stick to your clothing, stick right to the hair, and put a blanket on the mare to keep it in place over night. So it would be heat one night, ice the next. The robaxin and bute did nothing to help. I would also massage the area every night, to help prevent any adhesions from forming. It took about 3 months but she came back sound, pretty impressive for a horse of her age.

However, she pulled it again 6 months later, so perhaps it was not completely healed. Went through the same treatment, and retired her from riding (she had been in the lesson program at the farm, mostly walk trot kids).

Not all vet's go straight to the heavy duty expensive diagnostics and treatments, most of mine in the past and present give me all the options, and I tell them what I want to do and/or can afford to do. We discuss alternatives, to try to come up with the best course of treatment.

I agree, if you want to pull out the stops and go right to the highest level of treatment, then I think you should discuss it with the vet.

[deltawave]

I'm not aware of many really good "diagnostics" for a muscle injury. And the SI area is extremely difficult to visualize with anything short of CT/MRI.

Medicine is not like taking your car to the shop and plugging in the diagnostic probe, where the diagnosis pops up on the screen and you go grab a new part. :) Especially when the patient can't tell you exactly where it hurts and what happened! Often a good working diagnosis, followed by a trial of empirical therapy for what you think is wrong, gets the job done and all's well.

[animaldoc]

Beacuse if we immediately offer the higher diagnostics - we're just out for your money, and if we don't we're cutting corners. :)

Seriously though - this is why good communication with your vet is essential. If your vet sees your horse and recommends A, B, C, you can always ask them. Is there anything else we can do? Any test that might tell us more? Etc. Your vet will probably tell you what else is out there, what their luck has been with a specific diagnostic/treatment and why they didn't recommend that originally.

And like someone else said - it's not like fixing a car! We try things and see how the horse responds and then try something else or adjust as we go.......

Sounds like a reasonable course on the OP's horse....

[lindsay_aggie]

In my experience it seems like communication between clients and vets is often poor. I worked at a clinic for four years and now work for their largest client so I have seen both views and it has made me take a very direct approach to discussing diagnosic and treatment options.

It might sound cold, but I have predetermined limits to money and treatment for each of my horses. For example, I already know who would get colic surgery and who wouldn't. It depends on age, overall health, insurance status, and many other factors. If I have a horse colic I go to the clinic and say "On this horse I will go only as far as fluids and supportive care. If this horse needs surgery it is simply not an option and I will euthanize." or "If this horse requires surgery I want it done as soon as that determination is made. Can I go ahead and sign an anesthesia release just in case?"

I have had to make that call before and unfortunately euthanize the mare. She was older, a very hard keeper at best, cribbed through every collar we ever tried on her, and didn't have the temperment to be receptive to being confined for aftercare. It is a hard decision but at least I didn't have to make it while I was emotional.

I guess my point is that to an extent it is the client's responsibility to let the vet know how far they are willing to go with diagnostics and treatment. I can't count the number of times I have heard clients say that the vet is just out for their money and then turn around and say that the vet didn't do all that they could to save their animal. A lot of people also just nod and agree at everything the vet wants to do; until they get the bill. Not saying that you are like this at all by the way :) . Just giving my experence from the vet clinic standpoint.

[OceansAway]

Thanks for all the replies! I know there is not much that can be done diagnostic-wise for something muscle related; it's just that the vet didn't seem all that certain and said it might be a ligament injury instead or something else entirely. Since he wasn't sure, I was curious why more diagnostics were not offered. I'd rather be as close to certain as possible. It really could be that he wanted to try the cheaper/less invasive option first. My insurance covers all diagnostics, so that's not a huge issue for me. Of course I thought of all this this afterward, and the office was closed. Just trying to get a feel for what is standard since this is the first time I have ever had an issue with my horse.

I used to work at a small animal emergency center, where the highest level of diagnostics were offered first and THEN adjusted according to the owners financial situation/expectations. That's why I was surprised at how it was handled with my horse. In my experience, that always seemed to work better because ever option is laid on the table right away. I'm sure every business has their own method that works best for them. I totally agree that communication is important. Unfortunately for me, I am one of those people that thinks of all this stuff later on :)

I just want what's best for my horse is what it comes down to, I guess!

[Chief2]

Perhaps reminding the vet that you have insurance so that cost is not an object would help to change his approach with your horse. Another option would be to run the horse up to the area large animal hospital and have the diagnostics done there. That is the place that would more closely replicate your small animal emergency care experience, as they tend to deal with a far higher concentration of people who either have insurance or the means to support the diagnostics than the field vets do. They still work the options in reverse, but you will have a wider variety of options to choose from.

To ask a field vet to lay out the options from top to bottom with his clients is to ask him to deal happily with explosive clients and summary firings. There's only so much of that they will take before smartening up and running through these options from affordable to expensive. I appreciate the conservative approach. My small animal vet's approach makes it look like they are doing me a favor by offering lower cost options after putting me into sticker shock with the top end options, and make me wish I never went to the place to begin with. Which is why many of us delay in going back, with some never going back at all. I wish more of these places worked the way horse vets do. JMO.

[deltawave]

I'd rather be as close to certain as possible.My insurance covers all diagnostics, so that's not a huge issue for me.Valuable things to mention up front. The vet can't tell by looking whether you have this mindset or are wanting to keep expenses to a minimum at first, if possible. Neither is "right" or "wrong" but it sure helps to know this up front. :)

I just want what's best for my horse is what it comes down to, I guess!

I daresay every horse owner would say this. That doesn't always mean "do every possible test immediately" is the best course of action. :)

[mybelle]

OP - Is there an update on your horse? I'm in a (re-)pulled muscle situation, unfortunately, so I am very interested. What about an ultrasound?

[mvp]

Please, please don't get mad at your vet!

He's trying to a) do the right (if slower) thing for your horse and b) trying to save you money.

Getting a picture of your horse's SI joint will cost someone a great deal of money. Just the picture. If you rush to do this and find a problem, I would not be surprised if your the joint becomes uninsurable when you renew your insurance. If you don't find anything, you still have cost your insurance company a wad of cash. How long to you think these guys will pay for a "throw all technology at a problem in pursuit of a quick and (maybe) definite answer" diagnostic strategy when the decisions are not theirs but the bill is?

If it turns out to be sore muscles that are, in turn, pulling on ligaments attached up high, you still have to treat that initial issue. Why not start at the apparent problem? This is a trusted strategy in diagnosing lameness. It may turn out that it's enough. You lose some time, but lots less money.