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mri vs wait and see

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  • mri vs wait and see

    In late October my horse had 2 fractured splint bones removed. I have been diligent with his program which included handwalking daily, then undersaddle 30 minutes daily which we did in snow, rain, you name it. Tested the trot this week and he is still lame. The surgeon blocked his leg and it is in the surgical area. He suggested an xray/ultra sound or 6-8 weeks walking under saddle again. About 3 hours from here is an equine MRI

    Has anyone gone through this? What would people do? I love my horse and want him to heal.

  • #2
    I guess the practical-minded me, who dislikes doing tests unless they are going to make a meaningful impact on the course of therapy, would be asking the vet if he/she thought that doing an MRI is likely to yield information or a diagnosis that would make a significant change in the horse's management.

    Wow, that's a run-on sentence!

    More briefly, does the vet think doing an MRI is likely to give useful information that would lead to a different course of treatment?

    If the treatment is going to be slow down and re-start rehab anyway, I'd probably skip the MRI. If he thinks there's a chip or nonunion in there that would lead to more surgery and/or a different plan, and that issue could only be seen by MRI, then maybe.
    Click here before you buy.

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    • #3
      Originally posted by deltawave View Post
      More briefly, does the vet think doing an MRI is likely to give useful information that would lead to a different course of treatment?
      This is almost always my question when considering diagnostics -- will it affect what we do? Will we still be doing lay-up, walking, or will there be other treatment options to pursue? And will it make any difference to look now, vs. in 6 weeks? I would discuss MRI with the vet/surgeon and see what they recommend.

      Assuming you'd be going to one of the WA MRIs (seem to remember you asked about this previously), they are both the type done under general anesthesia. I know for me, that affected my decision when MRI was suggested for one of my horses. He's ... special ... and I wasn't sure how he'd deal with the gen'l... In the end, I did do it, and while I got a good answer on his problem, he had difficulty with the process and I'm somewhat regretful of not shipping him south to a standing unit.

      Comment


      • #4
        Quote]More briefly, does the vet think doing an MRI is likely to give useful information that would lead to a different course of treatment?-deltawave[Quote]

        As usual DW hit the nail on the head.
        Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

        Remember the horse does all the work, we just sit there and look pretty.

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        • Original Poster

          #5
          mri

          good question thanks

          Comment


          • #6
            The problem with fractured splints is that you can take out the bone that is fractured, but that can still be suspensory involvement that causes lameness, especially if the fractured piece was large (and close to the top part of the splint bone - close to the knee).

            Since you're only 2 1/2 months out, you might just need more time. Suspensory issues can take 6-12 months to resolve. You should be able to image the area of the splint bones/suspensory sufficiently with radiographs and ultrasound. I don't see any reason to do a prolonged anesthesia and $$ MRI at this point....

            Depending on what you find, other therapies may help speed the healing - shock wave etc. might be useful.

            Comment

            • Original Poster

              #7
              mri

              thank you
              apparently the breaks were really far down in the very thin end, it is a hind leg. he said he felt it wasn't the suspensory but that sometimes when the bone remodels it can interfere or be sharp? or there can be adhesions. I am just really worried and want to make sure I am doing everything properly.

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              • #8
                I was in a similar situation where we just didn't know the diagnosis. And while I completely agree with deltawave's question about whether it would change the treatment, sometimes you need to know what's going on in order to know if treatment is working.

                Long story short, my guy had a soft tissue injury. We localized it to somewhere distal to the fetlock. After 1.5 years of rehab, he was still roller-coastering. We'd get to a certain point in rehab, then he'd go and re-injure whatever it was. I finally popped for the MRI and was VERY glad I did. We knew what ligament was torn, how big the tear was (career-ending), and where to put the u/s so we could monitor it throughout rehab to pasture-puff status. We were able to do minor surgery (splitting the ligament) to help with healing, which we wouldn't have been able to do without knowing where the injury was.

                If you have the cash, still consider MRI. But like animaldoc said, you're only a few months out. However, if I had done the MRI right off the bat, I would've saved thousands in constant re-checks, rehab, and other diagnostics.

                And I personally would prefer a unit under general; they give much better pictures. I think if you're going to do it, do it whole-hog. The price was very comparable between the 2. I did mine at MN, where they have an excellent anesthesia team, and my gelding recovered just dandily (he was older, about 16 at the time).

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                • #9
                  Originally posted by morganpony86 View Post
                  And I personally would prefer a unit under general; they give much better pictures. I think if you're going to do it, do it whole-hog. The price was very comparable between the 2. I did mine at MN, where they have an excellent anesthesia team, and my gelding recovered just dandily (he was older, about 16 at the time).
                  Again, I really think it depends on the horse. And what I understand is that the difference between the lay-down and standing MRIs is not so great on newer machines -- my own lameness specialist is installing an MRI unit that does both, and he's one to go for the best available. I think one factor is where they are scanning and whether movement is an issue.

                  When I compared cost, the gen'l anesthesia MRI cost was comparable to the total cost of BOTH standing MRI PLUS shipping my horse to CA -- i.e., comparing cost of gen'l anesthesia MRI to standing MRI side by side, standing was significantly less.

                  Comment


                  • #10
                    Originally posted by horsepoor View Post
                    Again, I really think it depends on the horse.
                    Agreed. But one shouldn't eliminate general anesthesia because one horse didn't do well. There's always a risk, but large clinics are very good at minimizing them.

                    Originally posted by horsepoor View Post
                    And what I understand is that the difference between the lay-down and standing MRIs is not so great on newer machines -- my own lameness specialist is installing an MRI unit that does both, and he's one to go for the best available. I think one factor is where they are scanning and whether movement is an issue.
                    Actually, the standing MRIs generally have smaller magnets (1-1.5T) than the general anesthesia ones. If I were to do the standing, the local one in my area (next state over) was a 1.5T, vs the 3T "lay-down" MRI. And the standing-MRI clinic quoted me a price that was only a few hundred $ cheaper than the lay-down, including anesthesia. The anesthesia & associated hospital stay was nothing compared to the price of the MRI.

                    In addition, no matter what you do, you always get some sort of movement artifact on the standing MRIs, especially if the region of interest is higher on the limb (so above the hoof). There is no movement artifact on those that use general. Therefore, the standing MRIs can only adequately get images in the hoof, whereas the general anesthesia ones can get images much higher on the forelimb.

                    For my kid, who is small-chested/shoulders, they were able to get halfway up the cannon bone. You definitely wouldn't have been able to do that in a standing MRI.

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