It would not be appropriate for me to make specific treatment recommendations for a horse that I have not examined, which is why I said that I would always defer to the vet who is actually managing Arty. As you were seeking input on how others might approach treatment in a similar situation, however, I was happy to share my general approach in a similar situation - my comments assume that his medical/neurological status is exactly as you described with no additional findings left out. As you know from reading these boards, different vets often have different approaches to treatment, so I offer those comments as MY approach and not as the single correct path to follow. I work in a hospital setting and tend to see more severely injured horses, so my approach may be more aggressive than some.
The rationale for keeping the head in a more raised position is to minimize further elevations of intracranial pressure. It is not clear whether Artyās ICP is even elevated, but in the absence of any information I would prefer to avoid giving him reasons to maintain a low head position for extended periods (such as eating hay from the ground). If his mental status were normal I wouldnāt worry about this, but since you compare his mental status to being āheavily druggedā I would consider this a possibility. This is also why I would use DMSO (and possibly other medications) even though the injury happened several days ago. It isnāt terribly expensive nor is there a significant down side - worst case scenario is that you administer it and donāt see much improvement. It is not unusual for me to continue anti-inflammatory therapy for more than a week after head trauma, but this is based on use of a different medication and repeated daily examinations to assess response over time, so I cannot say with confidence whether Arty will benefit from more bute. But this would be a great question for your vet, who I assume is checking him intermittently.
Recovery time can be highly variable and depends on the magnitude of the injury and the severity of the neurological deficits. We always tell owners that full neurological healing can take a year, by which I mean if the horse still has deficits at 1 year it is likely (but not a sure thing) that they will become permanent. But that doesnāt mean ALL horses take a year to recover - I have had horses that were down and comatose after flipping over backward look completely normal within 10 - 14 days. So there is no way to know for sure, but in general the faster they improve the better the chances of a full recovery. If Arty is improving each day that is very good sign and makes it very likely that he will make a full recovery relatively soon.
Whenever horse owners have concerns or questions about the vet services they are receiving, whether that is my care or that of another vet, I always recommend getting a second opinion. If Vet #2 has the same recommendations it will help to ease your mind that he is getting good care, and that you are doing right by him as his steward. If not, you can choose the treatment path you are most comfortable with.
Best of luck to you both!
Iād still like to give him 2-3 months off to be safe, more if