Cross-Post: Please Help Me Decide

[fanfayre]

I am cross-posting here from Horse Care, as it’s more specific to dressage, and not everybody goes to the Horse Care page, and I value all of your collective wisdom and input. Warning, this is looong, but I wanted to give as much data as possible.

19-year old gelding (ex)eventer, now transitioned to dressage (with a bit of low-jumping for cross-training), and aiming for 3rd level this summer.
I have read up all the threads I could find on PSL injuries, treatment and outcomes.

Presented December 19th with hitch in LH, treated with paddock turnout rest for 8 days, when not better added 1g bute x2 daily for 7 days, but then developed abscess in RF, so LH took a backseat. Just as abscess blew, 18-24" snow arrived for 7-10 days. Once snow melted and was able to reassess, hitch in LH still present. Took him to my vet the next day, Flexions returned no increase in lameness during lower leg and hock flexions, but increased when stifle flexions conducted. No x-rays or ultrasounds performed*. Sent home with instructions for strict stall rest, back on 1g x2 daily bute for 10 days, reassess in 14 days. If no better, then vet would refer me to lameness specialist associate (I feel I should mention I have a very good 33+ year relationship with my vet, who is board-certified- she did not shirk her duties [see below]).

• My vet did not do x-rays or u/s because she said IF stall rest + NSAID did not fix the issue she would be referring us to a specialist who would be redoing the same x-rays and u/s with far better equipment than she had, so why waste my money. I agreed .

After 3 days of stall rest (not a problem- he likes his stall!), another horse rehabbing a different injury (and sadly the one my guy is completely attached to- I joke he’s attached at the brain) left the barn for her exercise, and my guy lost it. Kicked the stall boards, completely lathered, screamed himself hoarse. I emailed my vet, who thought he was having an issue with stall rest, but told me to contact the specialist. We developed a coping strategy to get through the next 10 days during the 40 minute separation until our specialist appointment.

Which brings us to now. The specialist was very thorough, redid our initial investigation, same results to flexions, so we started the rads and u/s of the stifle, which showed clean for his age and level of lifetime activity, so that was good, I guess, but it left us wondering what the problem really was.
The upshot is he has an injury to his upper proximal suspensory ligament . No u/s was performed that day because too mush fluid for blocking had been introduced.

Here;s where I need your help:
Which treatment option do I choose-

1. PRP (or other biologic) + SWT + rehab (how long?) Performed by the specialist who diagnosed PSL
2. neurectomy/fasciotomy + rehab? (again, how long?) Performed by 1 of 2 other specialists I would have to approach.

Keep in mind he’s 19. I have been told either of these options would very likely return him to our level of training/competition IF rehab was successful following either treatment. Both options appear to be within a few hundred $ of each other, fully out-of-pocket.
I suppose, even if he returned to trail-riding sound, it’s better than he is now…

There is, of course the 3rd option: retire him right now, but as sore as he is, and with the low success rate of Dr, Green solving this problem, euth is the more likely 4th option, but one I will consider so as not to make him suffer.
Or is there a 5th option we haven’t considered yet?

Thanks so much in advance!

[Cowgirl]

How bad is the hitch? Can he lay down and get up? I’ve had two older horses that I’ve had to make decisions on. The first one at age 24 tore a front tendon, and could no longer lie down or get up. He did it becuase he had other issues and was not laying down and propping himself up on that leg when sleeping. There was no way back from that because he would have the same issues that caused the tear AND I did not want to attempt stall rest with this horse at age 24 (he would not mentally handle it well). I pumped him full of drugs (which will always make you question your decision because it helps them feel better and look sound) for a week while I made arrangements and euthanized him. It was the right decision. The second one had an injury to the extensor process of her right front coffin bone at age 15. I was showing her at Grand Prix at the time. I had the chip fracture removed and she went to a rehab facility for 9 months then I spend another year bringing her back and showed her at Grand Prix again at age 17. I had to give her prostride and osphos to maintain her because the surgery caused arthritis. The following year, I did one big clinic with someone I always wanted to train with (Conrad Schumacher). She peaked at GP that year. I then retired her from showing. I continued to maintain her and ride her at home for 3 more years while my young horses were growing, but then fully retired her at age 21 when she was showing signs of compensatory issues (and confirming xrays that her coffin arthritis was worsening). I want her to have a long full retirement as she earned it (I have owned and trained this horse since she was 7 months old). I no longer give her the prostride and osphos. She gets daily equioxx and is comfortable enough to move around in the pasture with her friends. I have to continue supportive corrective shoeing on her front feet at $250 per cycle and she has a dental issue (a deep pocket issue) so she gets 2x per year dental care. So she is not cheap to keep. She is now 24, but she looks good and moves well and has a really good quality of life. I will likely not offer more medical intervention, but as long as she maintains well with the shoeing and the equioxx and the dental care, and seems comfortable and happy, she is retired here and I enjoy her company. My questions for you are about the horse’s quality of life, what you want to do with the horse, are you able to afford to fully retire it and can you maintain it in retirement so that it is comfortable? Also, what will your triggers be to move on to the next level?

[fanfayre]

I would say 2/5, but I have not received the report yet with the vet’s classification.
Yes, he can get down and up, given the amount of manure stains on him
It’s his quality of life I’m most concerned about. He’s 2/5 at walk, and he’s turned out beside a fairly busy road, so the optics are a consideration even if he’s happy hobbling around, but it’s a knife-edge if he thinks he’s being separated or abandoned.

I would love to come back to 3rd, if all the stars align maybe some 4th level movements even if competition isn’t involved. I would settle for a nice hack.

[Cowgirl]

The additional years I got riding my older horse with supportive medicine were so well worth it–even the three years I rode her at home and stopped competing and clinicing. It is such a joy to ride a trained horse (speaking as someone who started all over again with two foals–one is 3 now and the other is 5). If you can successfully rehab and support your horse and he enjoys his job and you enjoy riding him, it is so worth it. But if the horse can’t be rehabbed and kept comfortable for riding, retirement is an option as long as you can afford to give the horse enough support to keep it comfortable. I think it is kinder to euthanize if you can’t afford to keep them comfortable in retirement.

[fanfayre]

Thanks for your thoughtful response.
Our philosophies align

[fanfayre]

I should add, that whichever treatment I choose, should it be determined that’s the best course of action, I will have suspensory shoes put on

[fanfayre]

Just in case anyone’s wondering, he’s the fellow in the photos on the “Matchy ” thread …

[fanfayre]

I posted this over in Horse Care, but have you seen/know anything about this?

[Sancudo]

I have done the neurectomy before, on a 12 year old, and would not go that route again. He had the side effect of both fetlocks dropping within a couple months of surgery and had to be retired, and eventually had to pts this summer at 20 when he could no longer get around or lay down.

[fanfayre]

Thank you!
This is exactly the kind of experience(s) I am looking for.
My deepest condolences on your loss. < hugs > (because there isn’t a sad face hugs emoji, only a happy face hugs)