Secondary update: creatinine is back to 1.8mg/dL!
He runs high. We will manage it.
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I wouldn’t bother with HA injections for this unless you do Legend. Biologics with good growth factors will be the best for long term cartilage health and surgery recovery. The goal would be to not have to repeat injections as much for maintenance by maximizing your initial outcome. I’ve been super happy with Renovo after trying it, but it is pricey for multiple sites. For a young horse, I might lean towards IRAP for the first round. Perhaps you’d get a good draw with more volume output. I’ve gotten as many as 5 1/2 shots out of one IRAP draw for a stifle, and I think that’s more volume per dose than you’d put in a single site in the knee. Renovo does have more IRAP proteins in it than either regular IRAP or ProStride, though.
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My n=1 experience supports this, too. Pulled a chip out of a fetlock. Cartilage looked good but horse remained pretty sore. Went IA with Legend with very little result. An IRAP series was curative and the fetlock was never again an issue.
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I had good luck with IRAP in a stifle, so I’ll probably do it for this too.
Wanted to do the IRAP when the sutures came out, but I need to recover a bit first. The extra $2600 (over quote + ball parked extra) that I paid at discharge was supposed to be my follow up cushion for this stuff 
The school said injections should be done 2-4 weeks out for from surgery, so hopefully I can hit close to that 4 week window.
The more I learn the more I think I’ll save money on supps and IM HA, and just go straight for IA biologics if I’m trying to target a specific issue. My dog has improved significantly on Cosequin, but he’s old and has a lot going on - it isn’t just one or two joints.
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I’ve had very nice results using biologics a little later in healing, both in horses and my own stuff, so if 4 weeks is still tight, delaying a little further may still be fine.
I was probably 6 mo post op when PRP finally got me over the hump with my own knee. The fetlock horse above was probably 3-4 months out.
Great if you can swing that 4 week timeline, but if you can’t, and it’s a little longer, I wouldn’t sweat it!
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I would definitely give him UlcerGard, especially if he is not normally stalled. I just took my horse in, he stayed 3 days and came back with ulcers.
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Oh yes. We are doing a 30 day round of abler and monitoring!
Pony is thrilled to go on his walk-and-graze outings, and the staff say his sweet personality is coming out. I think he’s just enjoying having things to do. I’ll go see him this weekend and hopefully take him out for a few minutes. I might pick up a bag of his favorite chopped hay and take some out there for a snack 
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How’s he doing?
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Update: horsey is doing well but is OVER the stall rest. We are keeping him drugged and with hay bags and balls but there is only so much you can do.
I DID just get an “additional invoice that may not be final” from the vet school… to the tune of another $1300. I seriously do not understand how this went from a pretty solid $3500 all-in quote to almost $10k now… with no additional complications outside of a blood test and two bags of fluid. He was in the hospital for two nights.
Ten thousand dollars. To remove two floating chips in the upper joints of the knees with minimal issues.
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Did you get an itemized bill? They should provide one. When my mini had surgery we went from $5,000 estimate to the final bill being about three bucks under $10,000 as he had some issues and I got a cost breakdown of every extra. I’d ask for one.
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Oh yes, I have an itemized bill. I SEE the math. I just don’t conceptualize it 
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Oh I understand that 100%! It’s just mind boggling how it snowballs. I am happy to hear he is doing well though!
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What are the extra charges that weren’t in the estimate?
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Well. Not so great update. The horse is quite lame on his “can we start limited turnout” check.
My vet is talking to the surgeon about maybe still turning him out in a 6 panel pen just for a change of scenery, and I’m working to adjust his shoeing as well. Personally I think this is a foot problem vs the knees but we will see - the video I got was very short.
Ugh. I don’t think any of this is unmanageable, I’m just tired and feel as if we are not making good progress - if this was all the knees, he was sound before surgery. Who knows if he would have stayed sound (there was some cartilage damage and those big chips), but we went from a rideable horse to very lame on stall rest. And it’s been a very expensive journey.
I’m fine. Just really hoping we can get him comfortable - I’m debating Cloud boots but the horse was less sound in boots vs shoes previously.
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We’ve had several in Woofwear Medical Boots. They are my absolute favorite even though they aren’t popular. We turn out in them.
I can’t remember if you’ve tried class 4 lasering. That has helped my horse who fell in the hospital a ton!! I bought red light pads from Schneider’s to use on him, as well. I get more response from that than the bemer.
I know it’s exhausting….
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I talked to the farrier. We are going to do shoes and frog pads (a setup that has worked before) on the fronts and maybe add hinds next rotation. He was graded 4/5 lame on one front and 3/5 on the other (based on trot ups no blocks). Reduced ROM in hand but full ROM when manipulating the joints in the stall, so I still think the feet are at the least contributing.
He’s barefoot now but was in a shoe/pad setup before surgery and was sound. We pulled the shoes for the operation (well, he pulled them in mud and we didn’t reset). I am hoping that a bit of paddock turnout and shoes will address the issue.
I’m still paying off the surgery, so biologics are out of budget right now but I want to do a round of IRAP as soon as I have the cash. I think it’ll help. I do have access to ProStride as well, but I don’t think it’ll be significantly cheaper at this time due to the different practices I’d need to use. Anyway.
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Ugh, I’m sorry. It super sucks when you spend a shit ton of money and the horse is worse 
Hopefully the shoes do it, but I’ve also just found arthroscopic surgery to need time, both for my own stuff, and the couple horses I’ve sent to surgery for chips. Idk, maybe sometimes it’s a walk in the park, and that’s why surgeons expect really easy recoveries? But taking longer doesn’t necessarily mean they won’t do well in the end. Sometimes they just need more time.
Did they give you the intra op pics of the cartilage damage? Just how bad was it? To the bone, or no?
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They did not give me those images. At least I don’t think - I should go back through my email.
I don’t mind giving him time, at all. It’s the balancing act with the mental and full-body consequences of restricted movement. And also my wallet - the timing has been atrocious.
I do feel as if I was undersold the enormity of what I was taking on. Which is part of why I started this thread - I was feeling underprepared. Perhaps the joints were worse than we thought when they got in there, but I was not told that. Not to mention the in-person conversations go (for example, not quoting) “horse is a bit off RF” and then the write up says “4/5 lame RF”. For me, that’s more than a “bit” off!
My gut is telling me that this guy needs more movement (within reason) and that the feet need to be comfortable to facilitate that movement. He’s been night and day with shoes on vs bare or boots in the past, so I guess we will try the shoes and just go from there.
I’m really just guessing here and have no idea if this is normal, or if the prognosis is good or bad, and I don’t have the funds to throw the kitchen sink at him (I did when we started this, but the unexpected cost plus the volatility in the market at large has us cutting WAY back on spending in every area of our lives).
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Your frustration is really reasonable. Hearing “a bit off” and getting a report that says 4/5 isn’t okay. Not getting the intra ops and a review of them isn’t okay. Not getting a frank convo before all this about what to expect isn’t okay.
Do you have a vet you trust outside of this group of surgeons? It may be a reasonable level set to get the intra ops, and any op report, and just see what they think of that.
Sometimes I think surgeons check out once they’ve done their piece, ykwim? They can be so focused on just the actually surgery. If you have a vet who can look at that what happened in surgery and give you an honest feel of “this isn’t bad” or “whoa this is a LOT” that might help with expectations going forward? It’s so hard to know what’s to come without a solid feel of what they found & what it might mean. 
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