I have been doing some research and it looks like arthroscopic surgery and debridement of meniscus issues (what the vet school suggested) is not well indicated in humans anymore but biologics and PT have a similar success rate. Of course in humans when things get really bad we just replace the whole knee which isn’t possible in horses but I’m happy to theoretically apply some of the research to horses anyways. I could maybe skip the surgery and do stem cells or IRAP or PRP on their own but I’m not sure since I don’t know what that would be cost wise.
This is assuming I can get her feet fixed. I’m sad for her and a bit for myself. When I took her on things were a bit different and also all signs pointed to her as a risky but not unreasonable project as a trail horse and happy hacker.
FWIW, I had a vet years ago who had a client with a horse with a “blown meniscus.” She said it had looked like a bomb went off in the joint. Horse came sound enough with IRAP to go back to it’s job, which was lower level eventing. I heard the story because I had a horse with a (much more minimal) stifle injury, and she recommended IRAP for us, too.
Stem cells (depending on which type you use) won’t be much of a less expensive option. IRAP may be worth a try for the stifle. So sorry you are in this predicament. It’s so hard when they have major issues young and you don’t have endless resources even for retirement. Many of us have been there.
The initial suggestion was arthroscopic exploratory surgery, potential debridement and stem cells and I believe I was pushing $10k for the “best possible treatment”, a figure I do not have to spend. Unless I was misunderstanding the price breakdown. I did ask for an emailed explanation of options.
Second best suggested was stem cells alone, then IRAP, then PRP.
Also, thank you. I’m glad I’m not alone, but it is discouraging.
I would hesitate to sink thousands into treating a stifle injury when you are swimming upstream against the feet. From a purely financial standpoint, and I know that’s not how we look at things but I just have to say it, at the end of this road you are going to have 6k, plus corrective shoeing over however long a time period, plus whatever your purchase price and carrying costs are, invested in a now 7 year old OTTB mare, and you have no way to know if the feet can actually be addressed in a way that gets her sound enough to go into work if the stifle treatment is successful. Does she show the temperament and training so far that she could be useful and happy with a very low level type job, if it comes down to that being her physical capability? I don’t think euthanasia is a morally wrong choice here, when those resources could be invested in one with a better outlook.
I would ask your vet to block the front feet, one after the other, so you can have an idea of whether both feet hurt enough that it’s hard to tell, or if neither are bothering her too much. I think that would be important information for me, personally.
Is that horse Druid? I’ve read about a horse called Druid that sunk and penetrated on all 4 feet. It took a lot of care and effort but he not only recovered but was back to being ridden.
You either need a vet and farrier in your corner or dedication and know how to do it yourself.
Part of the hard keeper bit may be due to chronic pain from the front feet and the stifle. Cribbing might be intensified because of discomfort. And could the front foot issues be from compensating for the stifle and weighting the front end to take pressure off the hind end? And if that is the case, will discomfort from treating the stifle injury exacerbate her problems in the front feet? I don’t know but this is something to think about. Horses seem to go to hell in a handbasket in a real hurry when one thing goes wrong. Hugs! I know you are trying to do the right thing, no matter what that is.
I definitely hear what you are saying. The thing is she seems to be a sweet and quiet horse that would be happy to do low level things, but she’s clearly in pain somehow so how much of that is not actually her personality? She could be a sweet and hot horse when pain free.
To me it sounds like the laminitic feet are more of the emergency. I’d see if I can get that under control and then address the stifle. Also, if the whole picture is not looking good for this horse, euthanasia is not the worst thing. Laminitis is very painful and can often become a chronic worry/occurence. I came within an inch of euthanizing one of mine for it, but instead paid almost 10k to New Bolton and another 18k for rehab so he could be in a controlled environment. I’ve been lucky that he has not had a recurrence, but it takes A LOT of management, and my horses live at home so I can do whatever I want for him. He has two dry lots in different states (more $$) and stall mattresses in his stall. Soaked hay, meds, etc etc. You can’t control a lot of those variables when you board. And it doesn’t make you a bad person to not be able to control those things or to euthanize a horse in pain.
I would guess that the stifle is not helping her feet by any means. Bute hasn’t seemed to help any but she’s never been one to do a lot of theatrics anyway. It’s the right stifle and the left front foot is worse which makes sense.
It is going to be really hard for me emotionally to admit that I can’t help her because I’m too poor - I’m not too poor to do some things but I am not able to spend $10k or really $6k without reasonable hope of a useful life. I also can’t support another for 30 more years unless something changes - and my retirees seem to be determined to live forever.
The laminitis is certainly the first thing I’m trying to address. Somehow the vet isn’t concerned or didn’t pick up on it and is leaving it to my farrier I’m not sure. But I got an update on the stifle and it was definitely worse than I was ready for.
On paper I’m not against humane euthanasia. I’ve just never been faced with one that wasn’t colic or severe trauma related so even considering it feels a bit like a betrayal.
I can say without a shadow of a doubt that I am not set up to manage such a horse. I looked at the emergency feeding protocol for IR and even some of the regular EMS/IR feeding regimes and I can say they would be extremely challenging. I can do part, but not all of that.
Well since the vet hasn’t given you any advice I will tell you what new bolton did for my laminitic horse:
Stall on comfort mattress that they sold which can be put on top of your normal stall mats (he went through many and they were like 120 a piece?)
Ice legs (just as good as icing feet) Multiple times per day
Bute for inflammation
Acetominophen for pain (11 grams two times per day is the dose)
Trazadone to make him sleepy and encourage him to lay down and get off his feet
Soaked hay for min two hours to get the sugar out
Ration balancer (Triple Crown 30%) to make sure he got the nutrition he needed while eating soaked hay (1 - 2 lbs 2 x per day)
NO GRASS AT ALL
They did metabolic panels and diagnosed him with Equine Metabolic Syndrome. He was then put on metformin 2x per day (1 gram per 100 pounds) and thyro-l one scoop per day.
his shoes were originally pulled, but when he was maybe 2-4 weeks in, he got heart bar shoes to start, but my farrier quickly decided he didn’t need them so he only had those for one or two cycles.
He was stall rested for 5 ish months (that’s why rehab. . .i didn’t have the best set up for that)
He went back to work approx 10 months later after he grew a new hoof
My horse’s case sounds like it was much more acute and severe than yours, but he didn’t have rotation.
There is a reason for the old adage, “No foot, no horse.” I highly second the suggestion to deal with laminitic feet before embarking on any other treatments.
You need a good farrier and vet who understand “orthopedic shoeing” for horses. I speak from experience. BTDT.
I’ve dealt with two horses going through mild acute laminitic episodes, and both fully recovered. But… both were linked to specific springtime conditions and caught within hours, and we were able to start aggressively icing. there was no rotation or laminar separation in either case. Did your vet mention anything about laminar separation?
I got metabolic panels done on both horses. One did have underlying metabolic dysfunction, that was addressed over time with aggressive management. Did your vet pull blood and do any metabolic testing for you?
Easyboot cloud boots are great for barefoot horses. I think I ordered mine from SmartPak. I also fed Triple crown SafeStarch forage for quite a bit, in addition to soaked hay. The SafeStarch forage is a great product.
Definitely ice like crazy. Ice boots on her front legs will help give some relief, if you don’t have any, they’re worth buying.
Here’s the thing… I’m wondering about the stifle and if the founder is a result of her bearing weight unevenly, and if she is hesitant to lie down and get off her feet because it is painful to get up and down given the stifle issues. I had a friend lose a horse to laminitis last year that was caused by a chronic injury to another limb. The horse was not bearing weight evenly, and was having a hard time getting up after lying down… so he stopped lying down as much. My friend spared no expense trying to treat all issues at once to ensure he had a comfortable retirement… but in the end… it was impossible to manage. The laminitis kept on spiraling out of control and eventually they euthanized.
If the vet does think that the stifle injury and pain is somehow linked to laminitis symptoms in the front feet, and is not at all metabolic … and if the best case scenario is for the horse to be a pasture puff, because the stifle is that compromised… if it were me, I would be heartsick but probably opt to euthanize. Laminitis can be so painful for them, and if it has been brought on by an uneven weight bearing issue, and she’s also dealing with stifle pain… it’s going to be so hard to deal with both issues and unwind this. Poor mare. Euthanasia would not be wrong in her case. Just my opinion.
Vet didn’t mention anything about anything really… no blood panels or boots (just stall rest) or feed changes or separation. They found the stifle after the feet and everything has been focused on that. I think they’re just more familiar with those types of issues vs the hoof and such especially since it’s not externally obvious something is wrong.
She has at least a daily roll, seems to get up and down fine and was taking naps up until recently. No one is napping during daylight hours anymore though so I’m not sure if that says anything, it’s super hot already.
I’m inclined to do some more research and talk to a few more vets before doing anything. I think I’ll need a new farrier no matter what which won’t be simple but likely not impossible.
Right now this is where I’m at as far as options for the stifle:
Do arthroscopy, see that the meniscus is affected. Poor prognosis. Inject with IRAP/PRP/Renovo/whatever and see how she does.
Do arthroscopy, see that it’s mainly the ligament affected. Better prognosis. Inject with IRAP/PRP/Renovo/whatever and see how she does.
Don’t do arthroscopy, ??? prognosis, inject with IRAP/PRP/Renovo/whatever and see how she does.
If I’m not going to let them debride anything, which I haven’t decided, I don’t see much point in diagnostic surgery if the treatment doesn’t change. I’m unsure if I’m missing something and need to chat with my vet again. Also, this is assuming we get the feet under control. So far over text my farrier seems unconcerned or at least thinks the X-rays aren’t that bad.
I hope this farrier is reading things wrong, but I will say, if you see any redness (pinkness) around the coronary bands, please act fast to limit suffering.
