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WWYD? (euthanasia??)

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  • WWYD? (euthanasia??)

    Long story short: my 17 year old gelding has been in the hospital a month for non-weight bearing lameness in his right hind. No one has any clue what is going on. There are no fractures, he has a small "bone bruise" (hot spot identified on nuclear scintigraphy, fractures ruled out by radiographs) on his tibia. He has no soft tissue damage that we can find. We've suspected lots of things, including compartment syndrome, and he had a fasciotomy last Friday. He'll improve a little, then plateau. But his "best" day (Sunday morning) was a kind-of flat-footed walk, still not bearing really any weight when walking. They did a muscle biopsy, and it looks like an infection, but there is no etiologic agent (e.g. bacteria or fungi), nor does he have any other indications of an infection.

    I have no idea what to do.

    He is perky, eating, drinking, interested in neighbors, 90-95% of the pony I know and love. I only say 90-95% because it's clear it sucks being in a hospital not being able to walk. He's taking care of himself by lying down a lot to protect his left hind from laminitis.

    His vets have not directly brought up euthanasia, but I think we have hit the point where they have done all they can think of and all we can do is provide time and see if that helps. But his hind leg is wasting away (he hasn't used it since before Thanksgiving) from not using it. I guess I just have no idea when I should "pull the plug". Should I just give him time until he tells me it's time to go? His vets keep telling me he "hasn't given up" yet...

  • #2
    If he were mine, I'd get a 2nd/3rd/whatever opinion, especially if money were not an issue. I'd get that opinion from the best available--Rood and Riddle, New Bolton, etc. Sometimes fresh eyes and a new perspective can do wonders.

    Sorry you're going through this.


    • #3
      WAIT! Before you pull the plug.........

      My horse is in a similar boat and I have had 2 vets now tell me that a horse CAN HAVE FRACTURES THAT DON'T SHOW UP ON RADIOGRAPHS. My horse has been "fracture lame" (grade 5/5) since early November, and 2 vets strongly suspect there is a fracture(s) somewhere, but it cannot be proven. So in all reality, we don't really know. But they both told me that we're going to treat her as if she's fractured, and she will be at least 6 months in a stall. Could take up to a total of 2 years.

      Both these vets told me that hairline fractures can cause significant, non-weight bearing, pain and lameness but be almost impossible to find on radiographs. They both told me that sometimes you end up taking 40 or 50 views before boom, there it is. Shows up in neon lights. Sometimes you have to make many adjustments on the machine, and the angle you take the film to make ti show up. The one vet told me when she was in school they made a bunch of students take films on a horse until they found the fracture. She said they probably took 60 films before the spiral fracture was seen.

      When were the radiographs taken? Both vets told me it takes about 2 weeks post-injury for non-displacement fractures to show up. Check out the thread about my horse, here on Horse Care. There have been a few stories of horses with fractures that didn't show up until many weeks later on radiographs.

      Personally I would not give up. Everything I've read about these types of injuries suggests that they do have very minor improvement, then plateau, then very minor improvement, then plateau. And it can take 6 months before they're sound enough again to begin hand walking. Then you can hand walk for a few more months before they can go back to any sort of turnout in a paddock.

      JUST last night my horse walked the length of the barn aisle without a hint of lameness. She still is extremely lame when turning, but on the flat and smooth, she is significantly improved. And this improvement occurred from one day to the next.

      I have been using a cold water circulating machine on the affected limb and I have noticed marked improvement since beginning to use it.


      • Original Poster

        LMTB- How do you suggest getting a second opinion? He is definitely not mobile right now, and he's in MN, rather far from New Bolton and R&R... I trust the surgeons, and he's technically had at least 4-5 opinions from all of the surgeons on staff since he's at the UMN, but you are right that it couldn't hurt to get a second opinion.

        Thanks for your story; I will check out your thread.

        If there is a fracture, it is essentially on a "corner" of the proximal tibia (in the stifle), where the fibula attaches. That is where the "hot spot" on nuclear scintigraphy is. They took rads at about 3 weeks post surgery (immediately before the bone scan), and multiple different views of the area. The surgeon is rather sure it's not a fracture, but was talking about re-doing the rads (for the reasons you mentioned).

        However, he is still non weight bearing after FIVE weeks. You said your horse was 5/5 since November, but last night walked fine...? So how long was she non-weight bearing?


        • #5
          It would be pretty concerning to me if he is still not weight-bearing, I'm sure a lot depends on the location of the problem though. Our mare had 3 fractures inside her hock joint and several hairlines all the way up her right hind leg. She started putting a light amount of weight on the leg again after only a few days. She laid down a lot to rest, too, which our vets also said was very good to keep the non-injured leg from becoming over-stressed. She was on stall rest for 8 months. We did an aggressive course of Legend & Adequan, too, which I think was worth every penny. If he doesn't look miserable/in tons of pain at this point, I'd be inclined to treat it like he has a fracture even if one hasn't been discovered if the vets agree. Fractures can take a while if that's what it is. If it's something else, chances are the continued stall rest would help anyway.

          What do the vets at the hospital say about injuries to that area in general though? If it is a fracture, do horses generally recover from a major injury there or is it in a place that they think he'd likely develop super bad arthritis after things have healed? This would be a part of the decision, too.

          We were lucky with our mare (knock wood), and things seem to have healed well. 4 1/2 years after the injury she does have some arthritis in her hock, but it's not too bad. Hopefully your guy can also pull through. If he takes a turn for the worse or if the vets think his odds of a successful recovery are getting slimmer, no one will fault you for having to make a tough decision though. It sounds like you have done everything you can so far and he's lucky that he is in such good hands. My dad used to say that having to make choices like this for our animal's welfare is when we must pay for the joy they have brought into our lives. Sending many jingles your way - please keep us posted!
          Blacktree Farm
          Lessons, Training & Sporthorse Sales.
          Blacktree Studio
          Graphic Design, Web Design & Photography.


          • #6
            No insight, only well wishes for you and your boy. As for WWYD, can you safely get him home and put him on stall rest at home? Save the money a bit and watch and wait.


            • #7
              (((hugs))) and well wishes.

              if the vets haven't mentioned it and he's still perky and otherwise unaffected, then maybe give him bit more time? i don't know. what a tough place to be in. sounds like he's in v. good hands with the vets and that you trust these vets. so maybe make it known to the vets that you'd like them to be honest with you if or when they feel there is nothing else left to do but to euthanize?
              TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique


              • #8
                When my gelding was suffering because of laminitis I kept waiting for him to tell me that he was ready to go and he never did. The day that we finally euthanized him he was nosing around for treats, whinnying for me and giving kisses. I kept hoping that he would give me some sign but he didn't and I had to make the decision myself.

                You know your horse and yourself!! Unfortunetly it is a decision that only you can make......I must say though that euthansia is the kindest gift that you can give your is a wonderful peaceful end!!

                Good luck!
                RIP Sucha Smooth Whiskey
                May 17,2004 - March 29, 2010
                RIP San Lena Peppy
                May 3, 1991 - March 11, 2010


                • #9
                  A fracture that doesn't show up on radiographs will light up in a bone scan.


                  • #10
                    If your vets have not yet done so, they might get a second opinion on the case fromt the vet school

                    they may be willing to review the imaging blood work etc and make an opinion.
                    -- * > hoopoe
                    Procrastinate NOW
                    Introverted Since 1957


                    • #11
                      Good lord, A2, this thread is Not About You or the filly that you insist on telling various stories about in every single thread you post on! This OP has the horse at the hospital and it has been there, being seen by live vets and she is following their plan.

                      OP, I totally feel for you in this situation. It's so hard to make that call when they are bright eyed and seemingly healthy. Well except for the leg that doesn't work, that is. Get all the opinions you need to make a decision. I am glad you have good help with him and really hope it is something that can be turned around.


                      • #12
                        My reply turned into 2 pages so I PM'd you my mare's story of a two month hospital stay due to a front leg bone infection.


                        • Original Poster

                          Thanks all for your support & insights!

                          He is at the university, so he's getting the benefit of a rather large "team", including surgeons, internists, acupuncturists/alternative medicine specialists, rehab specialists, and pathologists. And thankfully I worked there for 5 years, and know the majority of them on a first name basis.

                          I also chatted with my BFF, and she also assured me that it's ok to not euthanize him now. But I do worry about being in Diamond's shoes... but I think he's a big enough baby (which I firmly believe is contributing to the lameness) that if he was really painful, he would say something.

                          So, at this point, I guess I'm leaning towards keep on trucking until something else happens. Sigh...

                          Originally posted by marta View Post
                          so maybe make it known to the vets that you'd like them to be honest with you if or when they feel there is nothing else left to do but to euthanize?
                          I have. But thanks for the reminder. His main clinician is a friend of mine, and I have told her that I need preparation for that talk. She knows she can't come in and say "well, we're done. We gotta euthanize this afternoon."

                          On a somewhat morbid, but smile-inducing note, I had to tell my other two horses that there is absolutely no way they can even need simple emergency radiographs for the next 5 years because their brother has wiped Mom's emergency cash stash clean in a single month. Did I just jinx the both of them??


                          • #14
                            I would euthanize him.
                            Free bar.ka and tidy rabbit.


                            • #15
                              Knowing your docs and knowing what a ham he is.... When he's done, he'll tell you. I'd hang in there a little bit more with him if you can financially do it.

                              No real advice other than moral support and a shoulder to lean on.
                              University of Minnesota College of Veterinary Medicine Class of 2012
                              Member of the Asthmatic Riders & "Someone Special To Me Serves In The Military" cliques


                              • #16
                                A bone infection is possible by the sounds of it. One of my friends horses had an joint bone infection after surgery. It was resistant to all but one antibiotic where they actually had to go back under and implant blue bead antibiotics under the skin to cure the infection.


                                • #17
                                  If there is no sign of "real" infection, any chance it's autoimmune reaction and the body is attacking it's own leg?

                                  honestly I don't even know if horses can have autoimmune reactions, but I'm the curious sort.
                                  If i'm posting on Coth, it's either raining so I can't ride or it's night time and I can't sleep.


                                  • #18
                                    It sounds to me like you have agreat team that your trust. That is perfect.
                                    Truam, I don't get your post. Maybe you have read about ATwos issues on another thread, but I thought her ideas added to the conversation? Whatev..
                                    Morganpony, I will say if it gets to be too much financally or too stressful, it sounds like you have already gone above and beyond.
                                    Good look with this difficult situation.I had a horse with a difficult injury and I stated a prayer change to pray for guidance. My horse recoverd. 'Jingles, jingles, jingles!


                                    • Original Poster

                                      Originally posted by Brio View Post
                                      Knowing your docs and knowing what a ham he is.... When he's done, he'll tell you. I'd hang in there a little bit more with him if you can financially do it.
                                      LOL- I knew someone would recognize me (and my pony) eventually. Thanks for the additional "insider" view. It's been brutal not being there. But I am grateful that both he & I are familiar to everyone, considering I worked there and he spent 2.5 years coming in for monthly check-ups for a previous injury. It seems like everyone is doing their best to treat him as their own, which is all I can ask for. Though it's hard for me not to go into "teacher-mode" with his vet students on LAS. "C'MON, you don't know what muscles are on the cranial aspect of the tibia?!?! Did you learn NOTHING when I taught you?!?!"

                                      Finances aren't a (big) problem. His vet knows she essentially has free rein of my credit card (cards, if necessary), assuming there's enough warning for major deposits so I can come up with the necessary cash (by selling a kidney... ). And she says that considering he's a lot more comfortable than he was last week, she's hoping that all it is now is a long road of rehab.

                                      Originally posted by Fharoah View Post
                                      A bone infection is possible by the sounds of it.
                                      I think, honestly, at this point anything is possible. The bone bruise could "abscess". But a seasoned pathologist that I trust implicitly and know very well looked at his biopsy yesterday and indicated that the acute inflammatory response could be a result of muscle necrosis from the suspected compartment syndrome and agreed that an infection doesn't fit his clinical symptoms at all. Sigh. Back to "WTF is going on".

                                      Thanks again for all the support & jingles!!


                                      • #20
                                        [QUOTE=morganpony86;5297160]LMTB- How do you suggest getting a second opinion? He is definitely not mobile right now, and he's in MN, rather far from New Bolton and R&R... I trust the surgeons, and he's technically had at least 4-5 opinions from all of the surgeons on staff since he's at the UMN, but you are right that it couldn't hurt to get a second opinion.[QUOTE]

                                        morganpony, I was thinking that you could maybe get a phone consult with a bigger hospital? Send his case file, rads, bloodwork etc. and see what they have to say. I didn't at all mean you should try and transport him.

                                        I am a big fan of university hospitals myself--I have bypassed the local private equine hospital in favor of UW's hospital more than once. However, an outside/fresh perspective NEVER hurts, IMHO.

                                        I had something similar happen on a MUCH smaller scale this summer. My gelding popped a huge splint on his RF and was off on it for over a month. Ultrasound showed that the splint was rubbing the suspensory and causing damage. My regular vets, who I trust very much, just said "stall rest and wait." They were pretty adamant that nothing else could be done.

                                        I took it upon myself to search out a second opinion--contacted a UW-affiliated hospital and hauled my guy up there for an eval. He ended up be seen by one of the top equine surgeons in the country, who said that the splint could absolutely be removed to prevent further damage. They took the splint bone out and several months later, my horse is doing great.

                                        My point is that if I'd just gone with my vets (2 dr's from the same practice) I'd still be sitting around waiting to see if my horse was going to come sound or not. SO happy I got that second opinion.