Laminitis now hind suspensory lesion- when to stop fighting

[shanks_pony]

My 8 year old QH gelding has not had a good year. Without writing a novel, he had severe unexplained allergies for 4 months which involved long term steroid use. The internal medicine vet was concerned about laminitis so she recommended X-rays just to check. There were so signs of laminitic changes but there was a concern over navicular changes. So we went off to the lameness vet for further evaluation. This vet identified some fairly minor left front lameness but more importantly a significant right hind lameness that neither my trainer nor myself had really observed. This right hind was diagnosed through ultrasound and blocks as high suspensory.

Pro-stride treatment, shockwave, prescribed rest showed no improvement. At the reassessment the pain failed to block to the suspensory so a new diagnoses was made stemming from the fetlock tendon sheath and steroid injections were recommended.

These injections were done and the next days he came down with severe laminitis that he would barely walk. We did intensive treatment of the laminitis (8 weeks in imprint shoes, icing, laminil perfusion) and he improved significantly and steadily. There was one significant setback when we put metal shoes back on at around 2 months but he continued to improve after this . No rotation was observed on x-rays. The vet suggested gradually bringing back light work since he had recovered so well.

Early on in introducing light work we noticed the right hind was quite right but there was no point investigating further since the laminitis was still a huge factor. After a few weeks I requested another evaluation to see how his recovery was going. The good news was that his fronts only showed the very slight left front lameness from before but otherwise looked good. Right hind lameness was predominant. More nerve blocks and ultrasound and we are back to right hind suspensory lesion.

The vets have recommended fasciotomy and stem cell injection as the best likelihood of treatment but obviously no promises. Here’s where my question lies. Would you pursue any additional treatment…?

Important facts: He’s a competition horse and is not for beginners. He can be quite spooky and reactive.I’ve never had him on a trail and don’t have a trailer to get around (I rely on my trainer to haul to shows). When he is not in regular excercise he’s hard on the stall walls and will tear around his paddock. I board him since I live a 35 minutes highway drive away in the city.

I know there is a lot of criticism over putting horses down because they can no longer have an athletic career but he’s not a horse that would be easy in ‘retirement’. As a recovered laminitic horse I would be reluctant to just throw him in a pasture. So my question for the community is—

[seabreeze]

No criticism from me. You have done everything you can to get to the bottom of his issues, and the prognosis is iffy. And he’s a difficult horse for rehab or retirement. And when I read your title “when to stop fighting,” my first thought was, “When you start asking when to stop fighting.”

You know your horse best, better than what you can represent in a couple of paragraphs on an Internet forum. After the extensive treatments you’ve already done and the information that you yourself have heard from multiple vets, if you are starting to wonder if it’s time to consider euthanasia, it’s certainly not a knee-jerk reaction on your part. Again, no judgment here, just my best wishes for whatever you decide.

[Marla_100]

I feel for you, I’ve been there too. He’s young and should heal reasonably well with time. Sounds like the vet thinks he’s almost healed from the laminitis so that’s good. Suspensories take a long while to fully heal and sometimes Dr. Green and a
tincture of time really is the best course.
I’d probably turn him out with as much turnout as you can arrange. Steady movement is recommended over stall rest for many suspensory injuries, within reason and depending on the stage of healing.
Carefully monitor his diet to keep it low energy (low carb and sugar), lots of good quality hay, turnout with a quiet buddy
and see where you are in 6-8 mo.
I realize it’s hard not to feel down when you’re in the throes of injury and illness, but don’t give up yet, be positive.
good Luck to you and your horse.

[IPEsq]

I really feel for you. I don’t know if turnout would be good in the short run with that type of personality in a horse, it is scary to think they are going to go out and rip around on that leg…even if that behavior subsides over time, you have a current lesion now.

I have seen the therapies you have left not work to get a suspensory issue sound enough for competition again. It’s a lot of money and more time. Could they work? Yes. But I think the risk is not insignificant that it won’t.

It’s totally up to you what to do, but just because there are plenty of lame pasture ornaments that are happy does not mean that would be a quality life for this particular horse. Only you really can judge that.

[DunByMistake]

Sorry this has to be your first post! That’s a big one.

No judgment over here. You’ve done right by this horse and tried very hard to fix issues. The reality is not every horse is ok with living a life of turnout and unsound horses don’t always end up in the best situations. There is only so much that can be spent on vet bills.

My personal opinion is it costs as much to feed and board a sound horse as it does an unsound one. And if I am putting this much time and money in, I need to get some enjoyment out of it. There are plenty of other nice horses out there that need a good home and some love and attention. I don’t think anyone can judge you for letting this guy go and focusing your money and time on another horse. Honestly, I wish more people were as pragmatic as you about this. On this board and in life, I see people spending so much time and money on horses that are walking vet bills and probably won’t ever come sound enough again to do what they want and I think, why? Let this one go and find another great horse to put your love and money into and finally get something more out of horse ownership than just paying vet bills.

I’ve thought a lot about these kinds of situations with my horse and I’d do the same as you. It’s fair to give them the chance to come back from one or two things - but in situations like this where issues just keep coming up and prognosis is that good, sometimes the best thing to do is stop fighting.

[candyappy]

I would never criticize someone who decided that putting the horse down was the best option. How far to go before doing that is also up to you. As well as how much more you want to try and how much you can afford to spend.

[alibi_18]

I would never judge someone who has to take such decision. You know your horse best.

I’ve had to take a similar decision, I don’t wanted to give my problems away. Difficult horses with chronic problems aren’t the best to rehome.
Those who would «want » them are usually not experienced enough to take care of them.

Do what you need to do and forget about what people might say.

[Second_Star_To_The_R]

No judgment what so ever. I’m sorry you’re having to make this decision. I had a similar decision to make in June and as much as it PAINS me to say, there are more days than not that I wonder if I made a mistake by treating the horse.

Dex is a different personality than your boy. He’ll be fine as a pasture ornament. But honestly the pattern with horses seems to be that the fix for the initial problem has the potential to cause a new problem for which the treatment causes another new problem and the cycle just keeps going. It’s easy once you’ve healed the first horrible problem and beaten the odds to say “we’ve come this far, we have to keep going” and you wake up and 10k has turned into 25k and you say OMG what have I done!!! And WHYYYY didn’t I have insurance!!! He could be dead lame again in 3 months from all the navicular changes in his surgical leg.

I can say that I have learned some very hard lessons with this horse. But if I am honest, if I truly believed that pasture soundness was achievable for a horse that would be happy living in a pasture, I’d probably be dumb enough to do it again if my wallet could handle it. But I would NOT do it if I couldn’t have the horse at home with eyes on 24/7.

I can’t answer as to how your horse will do. But the Fact that you’re conflicted about it tells me whatever you decide, it will be because you have his best interest at heart. Sending good thoughts your way.

[sdlbredfan]

No criticism from me, either. You have gone above and beyond. If turnout and ‘tincture of time’ are not possible, it makes sense to consider the horse’s quality of life as being even more important than length of life.

[Lusoluv]

YOU know what’s best for your horse. And though it’s nice to get consensus, only you know the horse inside and out. You also know you haven’t come to this decision hastily or without pursuing treatment with thoughtfulness and vet input. Best of luck to you during this difficult time. Horses are very expensive, time consuming and emotional ventures whether they’re for pleasure, competition or a combo. Don’t concern yourself with judgement from others when faced with tough decisions - just be very honest with yourself. Good luck!

[Bluey]

Sounds like he is one of those horses that will keep hurting himself, one way or another, if he doesn’t settle to quit being hard on himself, especially when not in work.
Hard to get well when he is not being sensible, that ought to weigh in also in the decision to go on and give it a longer try, what are the chances that he will heal well, not keep re-injuring himself or adding new injuries?

The situation is putting you in a bind.
Maybe consult with your vets about all this, see what they suggest, taking into consideration other than just the current medical problems, but the whole picture of the, in general, difficult horse to manage?

[AKB]

I would put him down. Some horses are hard to rehab. It isn’t worth putting him through a rehab and putting yourself through a rehab that is unlikely to be successful.