Post Mortem Opinions

[pnwprincess]

Hi all! I would very much appreciate some honest insight, an M&M conference of sorts, into what might have been missed here (timeline below)? Symptom onset was so rapid and everything seemed so mild, until it wasn’t. This was my heart horse and I can’t stop going over again and again in my head that something should’ve been done differently. Thanks!!

25yo KWPN Mare (euthanized yesterday)

Generally healthy, with right forelimb issues since a career ending flexor tendon tear in 2014 and subsequent founder during turn out. Pedal osteitis in right forelimb as well. Well managed with corrective shoes and daily Equioxx for last 3 months.

Timeline:
12/4 - Presented with hoof abscess of right forelimb, began poulticing immediately and abscess had moderate drainage.
12/8 - Oozing cut noted on left hind cornet band
Vet came out: Abscess was not fully resolved, she removed the shoe and opened up abscess. Was not concerned about cornet band. Tachycardia noted and attributed to pain. Farm employees had noted mild inappetence, horse was eating when vet arrived, so this was also attributed to pain.
12/9-10 - Continued poulticing and abscess was draining well. Cornet band cut was bandaged.
12/11 - Horse was relatively sound by now and drainage stopped, appeared much more comfortable. Cornet band injury mostly healed and bandaging removed.
12/12 - Relatively comfortable.
12/13 - Cornet band began bleeding again. Photos sent to vets who recommended re bandaging but didn’t have major concerns. Evidence of possible white line disease noted on both back hooves.
12/14 - 15 - Poultice removed from abscessed hoof, hoof looked fairly normal.
12/16 AM - Lameness returned to front right, progressively became non weight bearing and thick unilateral nasal discharge noted.
12/16 PM - Vet visit: right front frog was necrotic and mostly torn off, this was not the case 12/14 evening, frog had begun to look a little funky by 12/16 morning but progressed very quickly, she was unconcerned about cornet band injury as it appeared to be healing. Tachycardia noted, along with 2 cracked teeth/dental abscesses found, sinuses fluid filled, labs showed mild kidney and liver disfunction, elevated WBC. Started antibiotics.

12/16 vet was mostly concerned that with the inability to provide NSAIDs in future (given liver / kidneys) she couldn’t be kept comfortable given the foot issues.
Spoke with my regular vet the morning of 12/17, who was less concerned with the foot, since she was more familiar with the magnitude of the issues in that leg (or lack thereof) but concerned that the blood work pointed to septicemia and that we couldn’t bring her back from the condition she was in.

We elected to euthanize yesterday (12/17 PM). By that time the horses condition had deteriorated, she was lame in both hind legs as well, tachycardic, increased resp rate, pale gums, non weight bearing in front right still, lethargic. While on Tylenol and 2 doses of antibiotics.

Never had a fever.

Given her final condition yesterday, I do think sepsis was the correct diagnosis and I do think euthanasia was the correct choice.
To provide better care in the future, I am looking for opinions on - Was the cornet band “injury” really Quittor? What was likely to have caused the sepsis? In a geriatric animal could this have been stopped?
Her teeth were last floated in September, should we have found the dental issues then?

Or do you all think that we did all we could and that some things are just not treatable? Especially with age… if everything was treatable, we’d all live forever

I did attach a photo of the back left, the back right looked like an abscess until the frog involvement and the nasal discharge was pretty typical tooth infection discharge.

[RAyers]

Yes, it sounds like the horse was bacteremic (pathogen in the blood). There is no way to stop bacteria from gaining access to the blood stream. They live in it already as well as in tissues such as bone, muscle, etc. where they have ready access to the vascular system. We see plenty of bacteremic cases where the patient never shows classical clinical indicators such as fever etc.

The pedal osteitis already tells you there was likely an intractable infection that could never be treated (bone infection can only be treated by amputation). What happened was simply an old horse whose immune system was faltering and couldn’t keep local control of the bone infection.

You did all that current medical knowledge enabled you to do.

[Sarah616]

@RAyers

Yes, it sounds like the horse was bacteremic (pathogen in the blood). There is no way to stop bacteria from gaining access to the blood stream. They live in it already as well as in tissues such as bone, muscle, etc. where they have ready access to the vascular system. We see plenty of bacteremic cases where the patient never shows classical clinical indicators such as fever etc.

The pedal osteitis already tells you there was likely an intractable infection that could never be treated (bone infection can only be treated by amputation). What happened was simply an old horse whose immune system was faltering and couldn’t keep local control of the bone infection.

You did all that current medical knowledge enabled you to do.

This is a fantastic post and I have nothing to add except please do not play the “what if” game with yourself. It will do nothing but cause emotional stress. This was an elderly horse who had a great life and was obviously very cared for, and you gave her as dignified an end as you could, without prolonging what sounds like an inevitable amount of pain. We tend to beat ourselves up after the death of a very cared for animal, but so many times the true answer is that you did everything you were able to and the vets were comfortable doing

[JB]

Wow, that was a lot to deal with, I’m so very sorry

While reading, my thoughts kept going to some sort of systemic infection, wondering if she also had PPID as a complicating factor. It could be that the teeth were the inlet for the infection, but they might have been incidental as well, or potentially even a symptom of the infection. Mouths are just icky places and are the reason a set of the population needs to take prophylactic antibiotics before dental work

Hindsight can be cruel, but I don’t know if even throwing all the strongest antibiotics at her on 12/4, knowing what you know now, would have made a difference. But you didn’t know anything then beyond an abscess on a foot with compromised bone already, and a “cut” which could have easily been hitting herself due to not moving normally.

So truthfully ,it absolutely sounds like all the right things were done with the information known at the time. That’s the best you can hope for, and honestly, as fast as all this happened, I doubt even suspecting septicemia at the start would have done anything but prolong the inevitable

It’s normal, or at least common, to play the What If game with something like this. But please don’t

Big hugs

[pnwprincess]

Thank you all so much
You’re all spot on that “what if” is such a dangerous game, but the affirmation that we’ve done all we could has quieted my heart and soul so much.

[endlessclimb]

I’m so sorry for your loss. What a lucky gal to have been owned by such a caring owner. Godspeed to her, and ((hugs)) to you.

[trubandloki]

So sorry for your loss!

It sounds like she had wonderful care from an owner who did an amazing job of putting the needs of their beloved horse first.

[skydy]

You did all you could. No what ifs, or if onlys, for you to be concerned about.
I’m sorry for your loss. Hugs from Colorado.

[Ghazzu]

I’m with RAyers and JB.
I suspect her age and probaable decreased immune function were factors in this case, and that you did what was practical/possible.
Don’t beat yourself up; you done Good.

[Groom_amp_Taxi]

As someone else who had a horse put down in the PNW yesterday (planned), I send my condolences. Definitely harder to process it all when events are accumulating and then you seemingly suddenly arrive at the decision point. I like @Ghazzu 's phrase “you did what was practical/possible”.

[fivestrideline]

Agree with everyone here but just wanted to say I’m sorry for your loss. You really went above and beyond and it’s clear your horse was loved

[pnwprincess]

I just want to say again, how much I appreciate everyone’s kind replies. I’ve managed barns of 20+ horses and something about this horse, this symptom trajectory and everything sent me into a tailspin of self doubt. If anyone else is in a similar spot and comes across this post - it’s okay to forget everything you know, crumble and doubt yourself, but remember… you probably did everything right. 24 hours of clarity and distraction (and the amazing affirmation y’all provided) have given me some peace.
They don’t live long enough, but we are so lucky to have them for the time we do.

[Alex_and_Bodie_s_Mom]

I don’t have much to add on the symptoms front, except to wonder if a foreign body was introduced to the hoof, which resulted in the abscess, but when it was trapped, it precipitated the rest. Either way, even if that was the case, I think it would not have ended differently.

She was very lucky to have you caring for her for the past ten years. Like others have said, don’t play the what-if game. It doesn’t do any good, and I don’t think you could have done anything differently.

[BayMoose]

Nothing to add, but I want to say that I am very sorry for your loss. It’s hard not to spiral into a pit of self doubt, but try not to. You tried and did all that could be done and you can take comfort in that.

[Fiesta01]

So sorry for your loss. What a lucky mare to have been so loved and so well cared for. {{{Hugs}}}

[4horses]

I suspect, and this is just my opinion… She had a broken tooth which allowed an infection to move up into her sinus. That infection then moved to the bloodstream, causing sepsis and laminitis/abscessing in her feet.

I had something similar happen to my dog. He went into acute kidney failure and had sepsis. No idea what caused the sepsis, but by the time we got him to the emergency vet, they said there was nothing they could do for him, without dialysis. They did do a necropsy which wasn’t very helpful in determining the origin of the infection. The only benefit of the necropsy was that they confirmed that euthanasia was 100 percent the right decision given some of the other findings.

Lots of people get their horse’s teeth floated but very few equine dentists are trained in recognizing periodontal disease in horses.

I don’t know that anything you could have done would have avoided this. Many (and I would say more like most) old horses have broken teeth, lost teeth, or periodontal disease and they don’t develop sepsis.

[4horses]

Oh… And the one equine dentist I know of that treats periodontal disease… A float starts at about $800-$1000.

[StormyDay]

Abscesses follow the path of least resistance. Usually that’s out. Unfortunately sometimes they go deeper in first. It sounds like that’s what happened here. It probably happened before your horse was even lame to tell you something was up. Once it’s in the bone there’s not much to be done. I’m sorry for your loss

[sorrelfilly721]

I recently lost a 2yo who spent about 10 days in the hospital with no conclusive diagnosis. I went over and over and over it in my mind trying to figure out what I could have done differently and what it was that went wrong. Finally, a good friend who had lost her 14 month old son the year before said to me, “Sometimes, you can do everything right”. This is a hard pill to swallow especially when you are a control freak like me, but it’s true. You just do the best you can and when it’s time to call it, you make it as easy as possible for them.

[OverandOnward]

@pnwprincess

Hi all! I would very much appreciate some honest insight, an M&M conference of sorts, into what might have been missed here (timeline below)? Symptom onset was so rapid and everything seemed so mild, until it wasn’t. This was my heart horse and I can’t stop going over again and again in my head that something should’ve been done differently. Thanks!!

25yo KWPN Mare (euthanized yesterday)

Generally healthy, with right forelimb issues since a career ending flexor tendon tear in 2014 and subsequent founder during turn out. Pedal osteitis in right forelimb as well. Well managed with corrective shoes and daily Equioxx for last 3 months.

Timeline:
12/4 - Presented with hoof abscess of right forelimb, began poulticing immediately and abscess had moderate drainage.
12/8 - Oozing cut noted on left hind cornet band
Vet came out: Abscess was not fully resolved, she removed the shoe and opened up abscess. Was not concerned about cornet band. Tachycardia noted and attributed to pain. Farm employees had noted mild inappetence, horse was eating when vet arrived, so this was also attributed to pain.
12/9-10 - Continued poulticing and abscess was draining well. Cornet band cut was bandaged.
12/11 - Horse was relatively sound by now and drainage stopped, appeared much more comfortable. Cornet band injury mostly healed and bandaging removed.
12/12 - Relatively comfortable.
12/13 - Cornet band began bleeding again. Photos sent to vets who recommended re bandaging but didn’t have major concerns. Evidence of possible white line disease noted on both back hooves.
12/14 - 15 - Poultice removed from abscessed hoof, hoof looked fairly normal.
12/16 AM - Lameness returned to front right, progressively became non weight bearing and thick unilateral nasal discharge noted.
12/16 PM - Vet visit: right front frog was necrotic and mostly torn off, this was not the case 12/14 evening, frog had begun to look a little funky by 12/16 morning but progressed very quickly, she was unconcerned about cornet band injury as it appeared to be healing. Tachycardia noted, along with 2 cracked teeth/dental abscesses found, sinuses fluid filled, labs showed mild kidney and liver disfunction, elevated WBC. Started antibiotics.

12/16 vet was mostly concerned that with the inability to provide NSAIDs in future (given liver / kidneys) she couldn’t be kept comfortable given the foot issues.
Spoke with my regular vet the morning of 12/17, who was less concerned with the foot, since she was more familiar with the magnitude of the issues in that leg (or lack thereof) but concerned that the blood work pointed to septicemia and that we couldn’t bring her back from the condition she was in.

We elected to euthanize yesterday (12/17 PM). By that time the horses condition had deteriorated, she was lame in both hind legs as well, tachycardic, increased resp rate, pale gums, non weight bearing in front right still, lethargic. While on Tylenol and 2 doses of antibiotics.

Never had a fever.

Given her final condition yesterday, I do think sepsis was the correct diagnosis and I do think euthanasia was the correct choice.
To provide better care in the future, I am looking for opinions on - Was the cornet band “injury” really Quittor? What was likely to have caused the sepsis? In a geriatric animal could this have been stopped?
Her teeth were last floated in September, should we have found the dental issues then?

Or do you all think that we did all we could and that some things are just not treatable? Especially with age… if everything was treatable, we’d all live forever

I did attach a photo of the back left, the back right looked like an abscess until the frog involvement and the nasal discharge was pretty typical tooth infection discharge.

What everyone else has said. Obviously you are a great owner who followed up intensively on everything as it unfolded. That in itself shows that you did all you could do for your beloved mare.

There can come of a point of no return. An animal (or person) no longer has the inner resources to keep going. One of the greatest blessings left that we can offer is a quick ticket out, to what can otherwise be a prolonged and painful death. You gave her that.

I had one crash hard at the age of 18. I had expected him to be around at least 10 more years, possibly more, given his seemingly robust self. A healthy well-cared for horse deteriorated to starvation thin in just 3 weeks, with symptoms of multiple, seemingly unrelated illnesses and infections. There had actually been a slow slide to this point for the last months / couple of years, always treating something, trying vets & homeopathics. But during that time no one thought this was terminal. Then it was like everything just went over a cliff, in a matter of weeks. The vet(s) could do no more. He lost interest in fighting, he just wanted relief. He got it with a free pass over the rainbow bridge.

It’s hard to accept when it happens this way, with so little warning or advance notice. Going from ‘how do we treat’ to calling the game, in shockingly short matter of weeks or days. But it can happen.

Your mare was very lucky to have you. I hope you’ll find peace in knowing that you did the right things for her. And it was better for her that you made the decisions that you did. Godspeed to your mare, grace to you.