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I need advice... torn meniscus

Horse Care
#1

So I was finally able to get mare in with a vet and get X-rays and ultra sounds done. She has a torn meniscus. Evidently it’s pretty bad. As in vet said during the ultrasound “oh. Yeah. That’s bad” lol. had the rads sent to two different surgeons and they both recommend surgery if I ever want to ride her again. Well she turns 15 in may and the $4500 price tag on surgery and the who knows how expensive rehab after, surgery doesn’t make sense. It also doesn’t help that every person I’ve talked to who has done surgery has ended up with a retired horse anyway.

So here is my issue. The vet doesn’t seem to want to give me much information outside of therapies AFTER surgery. Now that he knows I’m not doing the surgery, he’s just like “okay. Well good luck”. He has not advised me on her care what so ever. It was like pulling teeth to get him to tell me what I could give her for the pain now and even then he didn’t want to write the RX for it. He finally said he would send a RX to any pharmacy I wanted for equiox or previcox. He said both. Idk what the actual RX will be. I spoke with him today and I just had to put a horse down yesterday, so speaking wasn’t really on my agenda for the day… I’ll figure out which he is writing it for tomorrow. He also said Pentosan. Which I have already.

But thats all the information i was given given on how to care for my horse… so upon researching and speaking to others, stall rest was advised. Last week I specifically asked him after the diagnosis if I should turn her back out or if I should have her on stall rest. He said turn out should be fine… but every other person I’ve spoken to or looked up here on COTH has had their horse on a minimum of 30 days stall rest. Some on stall rest for up to 6 months to allow it to heal and rest and then move to hand walking etc.

Can someone please help advise me on what I should be doing? I went ahead and put her in the stall after the first day. Should I put her on the previcox and the pentosan? Or just one? I’ve got the pentosan Gold, so theoretically it should have the same anti inflammatory aspects as the previcox? Any and all advisement is greatly appreciated since I feel like the vet is not being very helpful.

Also, I am planning on starting her on regular PEMF treatments as well (weekly) and possibly renting a machine for a month to treat daily (multiple times a day) to aid in the healing.

Thanks!

#2

Ugh… my condolences.

I understand why you wouldn’t go the surgery route. We didn’t either.

My then-6 y/o TB had a torn miniscus, and it is something I never want to deal with again. It was a long, endless process. He was never consistently sound after. I don’t want to scare you, but his injury was pretty bad and even after injections and lots of time off and careful reconditioning, he was still only “servicably sound”.

It’s really crummy your vet isn’t helping you with a rehab protocol? I’ll tell you what we did with mine.

IIRC, he was in a stall for about a month before he graduated to a teeny medical paddock - it was probably about 12x40 - big enough to move around but not big enough to pull any stupid stunts. He was in this turnout for the better part of a year before he graduated back to 24/7 TO with the herd. He was kept on lots of MSM and IIRC, was on maybe robaxin? I’ll have to double check, it was a long time ago.

It’s my opinion that the stifle is one of the few things you WANT to stall for while it’s healing. And I’m a big 24/7 TO proponent. Once it’s healed though, they need to be out and moving 24/7 to keep the stifle conditioned. My guy could NOT be stalled without being crippled within a few hours. You’ll need to manage the inflammation and pain, so I think Previcox is a good idea, and MSM and other joint supplements wouldn’t hurt either. We did not do PRP or shockwave or anything besides injections.

We gave him about a year off and brought him back to work - he was always very weak on that side. He was servicably sound, as in, vet and trainer thought he was sound enough to do LL eventing, but I really hated riding him because some days I couldn’t tell if he was just weak or lame. He was also one of those horses that just LOVED work and attention and would have slugged through pain without batting an eyelid, so it was really hard because he wasn’t a quitter, and he wouldn’t “tell” you he was in pain. I had vet and chiro look at him and they always said it was just a weakness, give it time, etc, but it really bothered me. I was so anal-retentive about his reconditioning schedule - I think I did almost a straight year of just hacking before he even went back in the ring. We did do some swimming at a nearby lake a few times, but not as often as I would like - hydrotherapy is IMHO one of the best things you can do to strengthen stifles. We ended up giving him a few years off while I went to college. I brought him back to work again, he seemed okay - sent him out to a friend to lease because she was horseless and while he was again, servicably sound, he was not what I would describe 100% sound. He had good days and bad days.

He ended up getting a bizarre freak paddock injury to that stifle while he was out on lease - somehow, he punctured right through the joint. I think his paddock mate kicked him, personally – and I didn’t know he was out with a horse with hind shoes. We had to put him down because surgery was not an option for him; he was 14, there was no guarantee he’d be even pasture sound, and IMHO he wouldn’t have survived the intense stall rest & rehab… It was an awful, crappy situation (and it happened on Christmas Eve too) but I know it was the right one: he would have been miserable in the year+ of stall rehab.

Once your mare is back in work, if she is, look into Estrone. I used it with good results.

anyway, one thing I’ve learned helps stifles once they’re back into work - hack them out, and warm them up/cool them down over about 5 walk poles in a row. Don’t overdo it, but do a few laps of the poles and then go on a hack, then come back and do a few laps and call it a day. I did that for about 6+months with one of my current (unrelated) geldings that had weak stifles and it made a big difference.

#3

I’ve already decided that I won’t be returning her to work. I just want her to not bite me when I touch her and not be sore everywhere! If she is able to return to light riding, cool, but if not, no big deal (I try to keep telling myself without crying!). I don’t want her walking around in pain. That’s no life to live. But the vet didn’t really lead me to believe that was an option without surgery. Which is why I turned here… I wasn’t kidding when I said vet choices are iffy. And this particular one is supposed to be the best here. Most everyone I know who referred me to him had experience with him before he moved practices. Now he is at a big money fancy practice so I just get the feeling I’m not high on the list to help since I won’t be hauling in weekly for stem cell therapy…

ideally, if possible, I’d like to get her sound enough to breed. As that was my intentions next spring anyway. But as of right now there is no way I can even consider that as bearing just her weight is too much.

Thank you for the advice. I tried to put her in a 12x24 stall, but since she is small she manages to get up quite the speed and high bucks in that, so she is back to 12x12. My thoughts are as soon as she isn’t kicking and biting me, I’ll have ultrasounded again to see how it’s healing before giving her more room.
Im lucky. Aside from her being a stall walker and making a mess of her stall (I’ve recently learned stall matts help keep stalls clean!! Never bothered putting them in since my floors are dirt and I rarely ever have a horse in a stall for more the 6-8 hours and that’s only when weather is a problem or they are hurt), she enjoys being in and getting the attention. And getting feed more than once a day! I’ve had her since she was a baby, so she has always been kind of in your pocket.

What is estrone? I’ll have to look it up. She’s on MSM already since she have IAD and it helps. Along with the pentosan. I’ll get the previcox and hopefully she will be good to go! How long should she stay on that? Forever? A few months?

thanks again!

#4

Estrone is estrone sulfate and similar estrogen. It is injected IM and used for stifle issues because it is thought to have an influence on ligament laxity.

Sorry for the bad news on the injury.

#5

I have a vet in Colorado who mentioned excellent results on a horse with a “totally blown meniscus” (her words) with IRAP. The horse, IIRC, returned to low level eventing. Worth a shot?

#6

Simkie, the expense is just too great to spend on a 15 yr old who may return to low level Eventing. If it were $1000, I’d spend it to see what happens, but you’re looking at 3-5k if not more. Then by the time she is rideable, she will be 16… a 16 out of shape pissy mare really serves no purpose to me as BN isn’t where my sights are set nor are hers. She’s better off retired. Or with the next love of my life in her uterus.

#7

For IRAP? Not where I am. Less than $2k. I think the last time I went through it was $1200, all in?

Or less…

This is from when we did Blush about 10 years ago:

https://www.chronofhorse.com/forum/f…dated-post-99=

This also says $1k - $1500: https://equinewellnessmagazine.com/eyeing-irap/

$1200 - $1500 here: http://www.americashorsedaily.com/im…-treatment.pdf

#8

Reserpine? Robaxin is a muscle relaxer, while reserpine is a long-lasting sedative.

It’s my opinion that the stifle is one of the few things you WANT to stall for while it’s healing. And I’m a big 24/7 TO proponent. Once it’s healed though, they need to be out and moving 24/7 to keep the stifle conditioned.

Agree. An actual injury to the stifle is big cause for very little movement, as opposed to a “weak” or “slipping” or UFP stifle, where movement is critical.

Riot- can you at least get a referral to New Bolton or somewhere so you can get some sort of protocol to follow from someone who knows a heckuvalot about these sort of things?

Otherwise I can’t think of anything else that hasn’t been said to do - as little movement as possible (and drugs ARE your friend), whatever it takes to keep inflammation down (I’d use at least a preventive dose of Abprazole/pop rocks if using daily NSAIDs, whether firocoxib or bute), MSM to help inflammation, HIGH quality nutrition (ample protein and minerals), and just take things one month at a time.

#9

I would have to pay for the actually treatment as well as board for my horse during the treatment. Just the treatment is 2k here. Still not willing to throw that money away on a maybe. But regardless, a months board at the facility (driving back and forth is not feasible) will raise the cost significantly.

JB, regarding the diet, why do I need to change? She’s been getting all they hay she can eat all winter and is continuing that trend. She gets her MSM and remission mixed in beet pulp. I’ve also got her on aloe Vera juice. I’ve got a surplus of senior feed I could throw her way now…

#10

Oh. And UT has them. I’ve sent an email to the Dr. just waiting on a response.

#11

No - it was something for his muscle soreness and overall body pain from compensating. I’m pretty sure it was robaxin. We’ve never had to use reserpine, thank god.

#12

Agree with IRAP recommendation. Find somewhere cheaper if you can. I’m sorry, but not sure what you’re hoping to gain from this post if you’re not wanting to do anything. This horse is 15 not 25, worth trying to help IMO. Otherwise try a regular injection and then rest and Equioxx. Sounds like you care about this horse and I get not doing the surgery. Hope you can find a plan that works. I know what it’s like to spend a lot of money and be uncertain of the outcome. There are just no guaranteed results in veterinary or human medicine.
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1 Like
#13

To be fair, OP is not “doing nothing”. For some people, the $5k surgery is not an option, especially since there is absolutely no guarantee the horse will be sound after surgery. I would make the same call honestly, if it was a horse that was not an UL horse and 15+… I have other horses to feed, bills to pay, etc - that $5k is not a drop in the bucket for most people.

Most vets call what OP is doing ‘conservative management’ and it is a perfectly valid plan for someone where surgery is not in the cards.

I think OP started the thread because her vet is not helping her decide what her “conservative management” protocol should be.

1 Like
#14

My mare tore her medial collateral ligament - so different, but in the same area. She was 4 at the time, and the best vets were very grave in her prognosis. There was no surgery as an option, they felt no IRAP or stem cell would help because she was young already. I put her on stall rest and prayers, I think against their judgement but I owed that to her. I put her on MSM and she was on previcox for a bit early in the rehab. She was ultrasounded two months later - she showed not much healing on ultrasound, but she was relatively sound at the walk, no circumducting at least. So, I gave her more time. We moved up to small turn out for a few hours and still stalled most of the time. In total she was stalled for about 6 months, and then turned out. She thankfully was a good patient and didn’t do anything too stupid when she was given more space. After 9+ months, the vets saw a video and told me I had to get on her … now, they suggested euthanasia when it happened because they didn’t think she’d even be pasture sound, so their suggestion to start riding was unexpected to say the least.

They never gave me a rehab schedule either, I just sort of winged it - conservatively. I never expected her to be riding sound, I just wanted to give her a chance at life. The vets said that since the ultrasound didn’t show much healing, she must compensate with muscles. I’ve never ultrasounded her again - I was devastated when the ultrasound showed no healing, but she clearly clinically appeared better - so now I just go by what she tells me. She’s very expressive and tells me exactly what she wants/needs/can handle and I don’t push her beyond her zones.

She had a catch in her gate at the trot for awhile that I could feel, and the vets described her trot as “asymmetrical” - not unsound per se. She’s now about 5 years out from her injury and we built up slowly - dressage lessons, hills, ground poles, ground work and now I don’t feel the hitch in her trot unless she’s tired. In the beginning she’d get cranky and do her “little dance” of small kick outs and bucks and tail swishing if I asked something of her she didn’t want to do. I never knew if it was she was in pain, or just being a jerk - but as she strengthened her leg that went away so it was pain, like I suspected.

She’s still on MSM, but no other supplements, I now don’t treat her any differently than any other horse - but it took a long time to get there. Afterall, I thought she’d never be sound, so riding her was just icing on the cake, but to have her improve so much and be a delight is just perfect. Stall rest I think was crucial for her, and thankfully she handled it well. We did a lot of hand grazing though because it was spring/summer/fall that she was in.

Best of luck with your mare!

#15

Thank you beowolf. You are correct. There are no “cheaper” options. And quite frankly I don’t think I’d want the cheap option to injecting something into my horses joint. I travelled two hours to the best vet to get a clear diagnostic on what was going on. Any other vet that has these capabilities are 4plus hours away. So the expense is going to be the same in the long run.
Yes, she is 15, not 25. She only recently came back into work (roughly a year back before being injured). Our only goal was to get back to training level MAYBE prelim before breeding her. Our last show probably would have been AECs. I might have pushed through the winter (next winter) and travelled to Fl to compete a bit, but aside from that, come April of 2018 she was retiring anyway. At 16. To make a baby. So yes, I could throw all the money I had set aside to do repro testing and breeding at her to maybe make her sound, but then I’m definitely not getting a baby or another horse next year. I have had intentions of breeding her since she was 8. So now she retires a year early. Yes, it sucks. But bringing her back to work is not the goal. Making her not be in pain is the goal. She isn’t the type of horse that can be in “light” work. She’s all or nothing. A trail horse or plodding around a 2’ course with a kid is going to make her miserable. Aside from working she likes eating and being pet. So she is going to do those two things from here on out.

What I need to know is should she be stalled? Should she get pentosan and previcox? For how long? What else can I give her? When should I start hand walking? Can I take her out in the suck and hand graze her or can she really not leave the stall at all? The vet I took her too is evidently only interested in helping if I do the surgery. Which I’m not doing. On top of this, I just spent another 1500 saving/putting to sleep another horse. Literally. Just spent. Paid off this morning. And being as I have another horse still (along with several dogs and cats who are needy AF), I don’t want to, nor will I, throw my safety net vet fund at an experimental surgery or therapy that even the surgeons don’t see a great outcome for her. The only “therapy” I’ll wastefully throw money at is renting the PEMF machine. For about $1000 I’ll get it for 3 months to treat not only her, which I already know for a fact helps her, but treat my other horse, two of my dogs with hip issues, and myself because I have an old back injury that is also helped by PEMF. So really I’m saving money.

Injections aren’t a good idea right now as they will only temporarily make her feel better and make her uSe the leg more. Therefore hurting it more.

#16

I don’t know if you quite understand how IRAP works. It’s not just a band-aid like steroid.

There’s also no need to haul her into the hospital to use IRAP. And there’s a new version out that’s a single injection, vs the set of three injections.

It sounds like you have a game plan, but it may be worth further investigation.

#17

Simkie, maybe I am not on the same page. My understanding that it’s a set of 3-5 injections into the joint spread 7 days apart. I was not given ANY information on ONE injection! I know it’s not like “joint injections”. My comment on injections was to syrieno on joint injections. That’s not an option because it will make her feel better. It won’t heal her. She will just hurt herself more from feeling good.

Im not surprised that I was not informed on this one injection thing… seems cost effective. Not the direction the vet is going for!

So I guess I should gather more information on your version! Surely he can do it. Is it guided like any other joint injection or will she need to be layed down for it? Is there a time frame from injury to injection as to where it’s most beneficial? A time frame that will make it less likely to help?

#18

For now… I would not hand-walk or graze. IIRC, I didn’t start either until about two months in. I did pull my guy out on weekends and give him a good rigorous grooming session, which he loved… but he was the type that wasn’t going to be an equine-kite if you pulled him out after long periods of stalling. With me, anyway. He was a different story with other people.

Sorry about the loss of your other horse.

#19

The new version is Pro-Stride, here is the first google hit: http://www.omveterinary.com/pro-stride

I’ve not used it, so don’t know a whole lot about it, but have seen it mentioned and discussed here :slight_smile:

IRAP in the stifle is done sedated and standing. They don’t need to be laid down. The vet will clip and scrub the area over the joint. The injection isn’t even ultrasound guided or anything. It’s really a straight forward sort of deal that can easily be done in a (clean) barn aisle.

We did IRAP for Dove maybe 6 months after she came off the track. At the PPE she was diagnosed with an MCL strain and my vet said it would likely resolve with time off. It didn’t, so we did IRAP before I started riding her in the spring. It just took two injections and she’s been totally fine ever since. I know you’re facing something far more serious with your horse, but it was really a terribly easy thing to do.

I also did IRAP for Blush eons ago when she had a chip removed from her ankle and we were struggling to get her pain free following surgery. Three rounds there, and we never had another problem in that joint.

I’ve never heard of doing FIVE rounds. Yeah, that would get up there (cha-ching!!)

For something like a meniscus, I would guess the sooner the better, but I really don’t know. We did Dove’s stifle waaaaaaay after whatever the original insult was, and got great results.

#20

She’s pretty good about not flying while grazing. Or has been in the past. She has been making escape attempts. I have to put a clip on her latch because I was a child when I got her (and she was a baby so I couldn’t ride her) so I brilliantly taught her how to do awesome things like untie herself or open stall doors. I forgot she even knew how to do that! I did pull her out yesterday. But only as far as infront of her stall to the cross ties to groom her and treat her feet. She’s got great feet, but I can’t pick the daily because she doesn’t want to hold her back leg up (bearing the weight on her hurt leg). I’m worried her feet will start deteriorating :confused:

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