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How much treatment for the really senior horse?

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  • How much treatment for the really senior horse?

    Ugh! I knew this day would come eventually but I was hoping it was still a long ways off. My 29 year old horse has been diagnosed with glaucoma. From everything I have read and what my vet has told me, the prognosis is not good. There really appears to be no long term treatment; he is on atropine, banamine, and some other drops for the glaucoma for now. He is very stoic, so he does not show pain, but she has said it is a painful condition. He has always been a bit of a prima donna and never liked being in a stall so he can be difficult to treat. Enucleation is an option, but he is already not really handling the loss of his sight well. I am not sure if putting him through that is the right thing to do. The other eye has pretty severe cataracts as well, so he could easily get this in both eyes.

    On the one hand, I am not ready to lose him...especially to something so basic as an eye issue. On the other hand, I don't know if his quality of life would be good with very limited vision and/or a lot of time in a stall.

    Any insight would be appeciated!

  • #2
    They can inject the eye so it shrivels up (gross, I know) but would be an easier recovery than enucleation
    chaque pas est fait ensemble


    • #3
      At 29 he deserves whatever option will ensure the best quality of life and minimal pain. Does the vet think that he is still in pain despite the medication?


      • #4
        "Treatment for glaucoma depends both on the primary cause of the disease and if the eye is visual. The goal of treatment for glaucoma is to increase the outflow of fluid in the eye. Medical treatment of glaucoma includes medications which decrease aqueous humor production (such as Timolol and Trusopt) as well as non-steroidal anti-inflammatory drugs (such as Banamine). If medical therapy does not adequately decrease the intraocular pressure, cyclophotoablation is an option in order to maintain vision. This procedure uses a laser to destroy the ciliary body (the structure in the eye which produces fluid). In horses that are blind from glaucoma, are often painful due to the increased pressures within the eye and if the horse is not comfortable with medical treatment, enucleation (removal of the eye) is frequently recommended. Please contact your veterinarian if you have any questions or concerns regarding glaucoma."


        "Treating glaucoma in the horse, as in other species, is challenging. Because of the propensity for uveitis to be a predisposing factor, oral and topical anti-inflammatory therapy is often indicated. There are some data which suggest that inducing mydriasis could be beneficial in increasing aqueous outflow, thereby lowering intraocular pressure in some cases. However, these data are far from conclusive, and it is known that dilating the pupil can increase intraocular pressure by closing the iridocorneal angle. Our opinion is that these medications should not be used for treatment of glaucoma. There are several topical anti-glaucoma medications available, though these are not effective enough to be used alone. The most effective long term therapy appears to be cyclophotoablation and hot tip sclerostomy using a diode laser. General anesthesia is necessary, and the procedure takes about 30 minutes."
        ... _. ._ .._. .._


        • #5
          Tough call--it's hard to summarize what is really a very personal "ethics" type question on a BB.

          Is there any indication that the horse is really in pain? Heart rate, sweating, squinting, etc? Do the meds seem to give any relief that you can notice, so you could tell if they were no longer helping? It would be so much easier to make these tough decisions if we could be sure of how much discomfort they have.

          What would his quality of life and expectation for longevity be without the eye problem?
          Click here before you buy.


          • #6
            We had the injection done on our very senior dog. It bought us another good 2 years. It was a much cheaper and easier option for her. Glaucoma is VERY+++ painful-the dog was pretty stoic but I knew a human with it who passed out from the pain. For our dog it was surgery or pts. Jingles for the right choice and best possible outcome-even if that isnt the one the two-legs would prefer.
            ~Former Pet Store Manager (10yrs)
            ~Vintage Toy Dealer (rememberswhen.us)
            ~Vet Tech Student
            Mom to : 2 Horses, 4 Dogs, 2 Cats


            • #7
              I just made the decision to put my old guy (29/30) down last month. It was an extremely difficult decision for me tomake, especially since I wasn't there to hug him goodby. My husband had fulfilled my childhood dream by buying him for me 27 years ago. Then he built me our small farm so I could have him at home. He taigjt me everything I know. Other horses have come and gone, but he was the one fixture in my life. My kids grew up, married and moved away. The grandkids came to visit and got their first rides on him. My husband died 4 years ago and there was my buddy to help me try and cope. I'm crying as I try and write this. In some respects he was the last thread of the life and dreams I shared with my husband. He was in pain. Speaking with the vet, we could get him through this crises, bit the underlying causd would not go away and would recur, a week, a month, 2 months, there was no way of knowing. But he was in pain and it would happen again. For one moment I thought of treating him so I could get home and love on him and say a proper goodby. But he was in pain, a lot of pain and would have it happen again. He had had a long, happy retirement with no illnesses or painful injuries. He had brought me more joy than I could imagine and was very very spoiled. I gave the word to let him go. He earned it. But when I return home next month, pulling into the drive and not seeing him there or hear him hollering for me.......there are no words. The depth of pain crushes me. For the first time simce my husband died, I'm actually entertainimg the idea of selling the farm and boarding my mare. I swore I wouldn't sell so lomg as my old guy was alive, as we'd built the place for him and it wss the only home he'd known since he was a youngster. I miss him and it hurts like hell. I made the best decision. For him. Have I had second thoughts? Of course. But the second thoughts are for me so that I could hang on a bit longer. And if he'd had a recurrence before I got home? He'd have gone through all that pain again? I had always said better a year too soon than a day too late. It was time to live up to the promise I made him. My only comfort is he only suffered a couple hours from onslaught to peace and he'll never hurt again. And I'm sure hubby was there to meet him. Sorry for the "book". First time I put all those feelings into words.
              In an age when scientists are creating artificial intelligence, too many of our educational institutions seem to be creating artificial stupidity.—Thomas Sowell, Is Thinking Obsolete?


              • Original Poster

                Thanks for the replies everyone! Maybe a better question would have been what would you do if this was your heart horse?

                I probably should have been more clear...he was pretty much blind before the glaucoma kicked in. He started losing his vision 4 years ago from cataracts and it has gradually gotten worse. The last few months he can see nothing in dim light and probably only shadows in daylight. So this is not really about saving any vision, just keeping him comfortable.

                He does not appear to be in much pain to me. But the vet said this is like having a constant migraine. I don't see a lot of pain between him being on meds and when he is not. But I hate to think I am missing signs of pain if he is in discomfort.

                I don't think he is in bad health for his age, but he can't chew very well anymore and he is beginning to get stiff in his back end. Normal issues. General anesthesia at his age and with his temperament would scare me quite a bit. I just don't see recovery going well.

                Has anyone personally experienced the gentamicin injection in a horse? I have been told that it is not very reliable and only has about a 60% success rate. He is currently not a candidate for this as he has quite a bit of corneal edema present.


                • Original Poster

                  Minnie-You've got me crying now! Your story sounds a lot like mine. I have had this guy for more than half my life and I can't imagine life without him. He was my first horse, a dream come true. So I am afraid of making a decision because I don't want to say goodbye.

                  I am so very sorry for your loss. Thank you for sharing your story.


                  • #10
                    I'm so sorry you're going through this. I know in the not-so-distant future I'll be dealing with a similar situation.

                    I just wanted to add that every horse I've known that has been enucleated has handled it EXTREMELY well. Once the "bad" eye is gone, they adapt quickly and regain confidence. If the vet thinks his vision is acceptable in the other eye despite the cataracts, he would probably handle it fine.

                    ...however, at 29, I think a bigger concern is whether or not you want to put him through a surgical procedure at his age. But as far as surgical procedures go, it is pretty minor and can be done in standing stocks with local anesthesia and sedation.
                    Don't fall for a girl who fell for a horse just to be number two in her world... ~EFO


                    • #11
                      I am sorry that you are having to go thru this. A couple of years ago, my mini gelding (27) stopped eating. Almost entirely. Treated for ulcers which didn't make any difference. At the same time, we were treating him for eye issues - pretty sure glaucoma. His quality of life went downhill pretty fast and he didn't take the loss of sight well at all. I made the decision to put him down rather than risk some sort of traumatic accident (even in his safe enclosure).

                      My thoughts are with you.


                      • #12
                        The problem with a heart horse is that I don't think anyone but you can really know the right decision. I wouldn't worry too too much about pain only because if you know a horse that well you probably "just know" if he is in pain. My horse had an enucleation last September due to a fungal infection in a corneal ulcer - one of our primary reasons for choosing that surgery was that it could be done under standing anesthesia instead of general. He is 17 with IR and Cushings, and I didn't think that he would do well under general anesthesia. He bounced back from the surgery about 1000x better than I expected - about the biggest issue we had was a little bit of difficulty getting him to walk straight into the trailer to go home a few days post-surgery. He had maybe a weeklong adjustment period where he would occasionally spook while hand-walking, etc. I walk/trot/cantered him an hour after his stitches came out, and he honestly had zero adjustment period by then. He probably could have gone back to jumping immediately, but we waited a couple of weeks because he was unfit and to be fair to him. If you see him now, you would have no idea that he couldn't see out of one eye, honestly I forget that he can't. He had been having some problems with that eye for a few months before (chronic blocked tear duct, etc), and it seems that most likely it was causing some low-grade inflammation. He was noticeably more comfortable even while still healing from surgery, and as much as I wish he still had both eyes, I think that in his case it was absolutely the right thing to do.

                        If it's possible, what I would really suggest is doing a surgery consult. A few years ago my heart horse went to the vet school at age 32 with a colic that was not resolving on its own. The colic resolved, but we did some diagnostics while he was there and discovered two enormous enteroliths that had somehow been asymptomatic, probably for many years. He had been retired for years at that point, but was happy and healthy, and I was really torn as to what to do. My vet insisted that we do a consult with a surgeon - not because she thought that he should undergo the surgery, but because she is very wise and she knew that I would live with my decision better (whatever it was) if I made it knowing all of the facts. She and the surgeon and I sat down for 2 hours (incredibly generous of both of them) and reviewed absolutely everything - outcomes of the surgery, outcomes for horses that age, prognosis without surgery, his odds and overall health, etc. Ultimately I decided not to put him through surgery, because at his age it just didn't seem fair, and he came home with a pain management plan in case they bothered him again. The vet school estimated that he probably had six months left, and we brought him home with a plan to keep him as comfortable as possible for whatever time he had left. He did not apparently listen to that memo, and enjoyed two more years of retirement before being euthanized for totally unrelated reasons. BUT, the important thing is that because of those two hours that we spent talking through the surgery, I never once questioned that I had made the right choice, and I will be forever grateful to both of them for giving me that.

                        I think it is perfectly valid, and often the most humane choice, to not do surgery on a horse because of age - but if you rule it out automatically because of age, I think it can be a very hard decision to live with.

                        Also, you may want to look into the Guardian fly mask ([URL="http://www.horsemask.com/"]) - especially if he doesn't like to stay in, it may keep him more comfortable.


                        • #13
                          Remember--no matter what the condition, no matter how dear and beloved the horse; the decision must be made based on what is best for THE HORSE, not "your feelings." Even if you are not "ready to lose him" (we never are!), I think you would not want to put him through long days and nights of unremitting, terrible pain just so you don't have to face letting him go. Unfortunately, I've seen people do this a time or two, and I just can't understand someone letting their "best friend" undergo horrendous suffering so they can keep him around.

                          I second Delta's objective list of pain indicators above; and these are the ones your vet will be going by as well. You might also check out the AAEP's website for their list of criteria for euthanasia just for checks and balances so you don't kid yourself.
                          But your observation of your own horse's ability to adapt is worth more IMO than the opinion of anyone (vets included!) who doesn't see him all day, every day--let alone that of random strangers on a chat board.

                          Good luck--he sounds like he's very lucky to have had you all these years!


                          • Original Poster

                            Thanks for the replies everyone! My computer was down for a few days so I was not able to answer earlier. My friend made him a mask with the bad eye completely covered so he will be more comfortable. He still does not appear to be in pain. After dealing with a corneal ulcer in my other horse for 5 months last summer, I think I am pretty familiar with the symptoms of eye pain. But this horse is so much more stoic about pain that I question myself daily on that.

                            Long term though, I don't think he has the temperament to deal with complete loss of sight. His cataracts in his "good" eye have gotten a lot worse in recent months. He is fiercely independent and none of this is boding well for the long term. So I guess we are just going to take each day as it comes for now and see how it goes. I don't want him to suffer or live an unhappy existence so it will never come to that.

                            I was truly blessed to have had this horse in my life. He took care of me all these years and now it is time to repay the favor.


                            • #15
                              I agree with LE. The issue is not whether "you are ready", but "is he ready".

                              I just lost my beloved dog. It was really hard. I took her to the vets, intending that she would not be coming home with me. But, in the waiting room, I rationalized that she was OK and we had more time together. So we left.

                              That night was horrible. She was totally out of it and would not eat, she peed and pooped in the house (for the first time in 13 years), and did not recognize me.

                              I looked long and hard at my motivation for leaving the vet's office that morning. I finally came to the conclusion, that I had brought her home because I was not ready. ---- But I realized that I was being selfish. SHE was ready and it did not matter whether or not I was. If I loved her I was not showing it by keeping her alive for me.

                              So, we went back the next day and I held her to the very end.

                              Perhaps I did need that extra day -- but she didn't.

                              I encourage you to not get into a situation in which he is either physically in pain or mentally in pain (such as forcing him to be stall bound when that substantially decreases his quality of life).

                              As long as you focus on his needs and not yours, you will do the right thing.
                              "He lives in a cocoon of solipsism"

                              Charles Krauthammer speaking about Trump


                              • #16
                                Corneal edema should not effect whether you can inject or not, so I do suggest you speak to a vet with more eye experience.
                                Previcox did wonders for my guys eye. Eliminated the need to inject or enucleate (my guy has a luxated lens from cataracts)
                                chaque pas est fait ensemble


                                • #17
                                  Originally posted by Lord Helpus View Post
                                  I agree with LE. The issue is not whether "you are ready", but "is he ready".

                                  I just lost my beloved dog. It was really hard. I took her to the vets, intending that she would not be coming home with me. But, in the waiting room, I rationalized that she was OK and we had more time together. So we left.

                                  That night was horrible. She was totally out of it and would not eat, she peed and pooped in the house (for the first time in 13 years), and did not recognize me.

                                  I looked long and hard at my motivation for leaving the vet's office that morning. I finally came to the conclusion, that I had brought her home because I was not ready. ---- But I realized that I was being selfish. SHE was ready and it did not matter whether or not I was. If I loved her I was not showing it by keeping her alive for me.

                                  So, we went back the next day and I held her to the very end.

                                  Perhaps I did need that extra day -- but she didn't.

                                  I encourage you to not get into a situation in which he is either physically in pain or mentally in pain (such as forcing him to be stall bound when that substantially decreases his quality of life).

                                  As long as you focus on his needs and not yours, you will do the right thing.
                                  THIS. I went the same route with my heartcat. I was keeping her alive past her time for my own selfishness. The day came when she didn't recognize me, and I knew it was past time.


                                  • #18
                                    There are no "school" answers to questions like this. Except the one that says, "spend what your ego tell you to and your pocketbook says can afford."

                                    Keep in your mind's eye, too, the Dollar Displacement Theory. A dollar spend on an old, infirm horse is one you don't have to spend on a young, healthy one. Or on training yourself to be a better rider, horseman, etc.

                                    If your pockets are deep then the limit is the bottom. If they are not then you set the limit.

                                    Best of luck in selecting your limits.

                                    Mangalarga Marchador: Uma Raça, Uma Paixão