Horse owners and vets face difficult decisions everyday. Vet Roger Lee lists the toughest choices an owner will ever have to make and shares his advice to simplify the dilemmas

1. When is the right time to put an old horse down?

This has to be one of the hardest decisions that owners face because horses and ponies become members of the family. Nonetheless, part of our responsibility as owners is to know when a horse’s quality of life has deteriorated to the stage where daily life is too much of a struggle.

Two of the biggest health problems for old horses are weight loss and arthritis. Dental disease and a reduced ability of the gut to process food means older horses eventually lose weight and muscle strength. Weakness combined with stiff, painful joints, makes it increasingly difficult for them to get up — a problem which becomes significantly worse in cold weather.

This means that many owners choose to give their horse a final summer and then put them to sleep in the autumn. Properly done, equine euthanasia is extremely quick and totally painless — and crucially the horse has no idea of what is being done.

I always advise owners that it is better to put a horse down while it is still enjoying life. Most people who know their horses also know instinctively when the time is right. If we wait too long, we risk keeping an old horse going for our sake, not theirs.

2. Do I send my horse in for a colic operation?

Over 80% of colic cases get better with just painkillers and gut relaxants, but this still leaves an unlucky minority that won’t recover without an operation.

Colic operations must be done quickly before the damage to the intestines is too great, so owners have to decide straightaway whether to send the horse for surgery or not.

Colic surgery has improved a lot in the past 30 years and is now a highly advanced speciality with success rates of around 70 to 80%. Send a horse with a surgical colic in early enough and there is a very good chance it will return home again.

Given that the only other option is putting the horse down, why might you decide not to operate? The reasons, as so often, come down to age and cost.

For older horses and ponies, particularly those retired or with other health problems, a major emergency operation may simply be too much to put them through.

The process is also expensive. The initial operation alone will typically cost three to four thousand pounds. If days of intensive care are needed afterwards, or even a second operation, the cost can be much higher — far above what even insured horses are covered for.

For some owners this simply isn’t affordable, particularly as there can never be a guarantee of success.

Following surgery, although there is a prolonged period of box rest — typically three months — there is almost no other aftercare or wound management needed, so cost after surgery is rarely a factor. Most horses tolerate box rest at home pretty well, despite their owner’s concerns.

3. When should a horse “pass” a vetting for purchase?

Few of us are perfect physical specimens, so why should horses be any different? Be it a turned in leg or a filled joint, a sarcoid or a small cataract, every horse will have a few defects that show up on a pre-purchase vetting — especially as it gets older. But does this mean the horse should “fail” a vetting?

The key point is that vets are assessing a horse’s suitability for its intended job and will recommend, or not, going ahead with the purchase based on what they find – it’s not as clear-cut as the horse passing or failing – and this is when the vet’s experience and judgement are crucial.

Clearly a child’s first pony does not need to move like a dressage horse. Allowances need to be made for age, too — a 16-year-old equine is not going to trot off after a flexion test like a six-year-old. A splint will be a big problem for a show horse, but not for an eventer. A young horse may be sound now, but have such poor conformation that it is unlikely to stay sound as its work increases.

The vet has to weigh up all these points and then advise the buyer. A number of findings that may individually appear insignificant can still add up to make a horse too big a risk.

Finally, remember that a vetting is just one person’s opinion on one day. It is not, and can never be, an absolute guarantee that a horse will do the job perfectly. For that you need a crystal ball.

4. Do I send my horse for an MRI scan?

MRI stands for magnetic resonance imaging — a powerful, non-invasive way of viewing the tissues of the body. In veterinary medicine it is particularly useful for imaging horses’ feet, because the hard hoof capsule makes it impossible to see or feel what is happening to the many important structures inside.

X-rays will show the bones, but with MRI we are able to get incredibly detailed images of everything else — including tendons, cartilage and ligaments.

In up to 90% of all lameness cases the pain is coming from the foot. Prior to the advent of MRI a significant number of these cases were left undiagnosed.

However, as with colic surgery, the drawback to MRI is its cost. The scanners are extremely expensive to buy and install and as a result an MRI scan of two front feet will cost in the region of £1,500.

This means that standard nerve blocks and X-rays are usually done first, and only if a vet is unable to pinpoint the cause of lameness will he or she recommend MRI. As an owner, you have to weigh up the cost — particularly if your horse is not insured, or if your insurer will only pay a portion of the cost — against the benefits of a scan.

Whilst an MRI will almost certainly tell you why your horse is lame and how serious the damage is, this is still only a diagnosis and not a treatment. It doesn’t make the horse sound again and unfortunately the inaccessibility of the injured area means treatment options are often quite limited.

Painkillers, steroid injections and time may be the only possibilities — the same treatments your vet is likely to have offered had an MRI not been done. So do you go ahead with an expensive scan that may not change the outcome?

Some people prefer a diagnosis to uncertainty, for others the high cost puts MRI out of reach.

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5. Should my horse have surgery for kissing spines?

Your horse has become reluctant to go forward and has started bucking when you insist. Suspecting it may have back pain, your vet X-ray’s the horse’s dorsal spines — the long, bony “fingers” projecting up from the vertebrae. Some of them appear very close together, with some bony reaction at their edges.

What should you do next? While the X-rays suggest your horse may have kissing spines, they are not conclusive. And nobody wants a major operation that isn’t completely necessary.

The problem is that dorsal spines are not fixed; they move whenever the horse does, so what looks close at rest may be touching when the horse is active. Equally it could be that the back is not painful and your horse is just misbehaving.

Part of the problem is that the clinical signs of back pain are often rather vague, so how can you be more certain that surgery is necessary?

One possibility is to inject a small amount of long acting steroid around the suspect dorsal spinous processes (DSPs). If the horse performs significantly better you have proved there is genuine back pain present. If the improvement is not maintained then you can go for surgery.

These days the operation to remove kissing spines is often done with the horse standing and it has roughly an 80% success rate, while the development of the keyhole technique in which the ligament between the dorsal spines is cut, rather than removing sections of bone is a far less invasive option.

• This article was first published in Horse & Hound’s Ask The Vet magazine

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I’m writing this from Scotland, having made my annual migration north to visit my family. We hit a new record this year by having three consecutive versions of Christmas Day, such is logistical task of getting my extensive family together! I love Christmas so it was no great strain to draw it out a bit for me.

Prior to heading up here for the holidays, I was lucky enough to be drafted in to help at Olympia throughout the World Cup Dressage at the beginning of the week. My involvement came off the back of our ongoing relationship with Team Hester and Dujardin and I assisted supergroom Alan Davies in looking after Uthopia and Nip Tuck throughout the show.

I’m pretty sure you’ll have all have read the reports by now and so I’m hoping there will be no spoilers here: what more could I have hoped for from my spot of moonlighting to have been there as the boys recorded a one-two in both classes each night?!

I have only been to Olympia once before as a spectator, and for me the place has an inimitable magic about it. The Grand Hall is utterly beautiful and there is an incredible stillness when it’s empty, the feel of which was in contrast to the electric current that ran through it when it was full. The horses were truly wonderful and emotions ran high after Uti’s win on the first night, and equally did so again when Barney recorded his fabulous win in the freestyle on day two.

The days were long – we were in the stables at 6.30am and didn’t leave until after midnight on both nights of competition – and so if ever I needed to be reminded of the amazing work of professional grooms, I certainly was here. These guys are truly incredible in their efforts to keep the horses in the best order possible and Alan in particular puts huge pressure on himself to keep everything just right to allow his horses to perform at their very best.

If long days needed an antidote, walking into the prize giving alongside Barney and Uti on respective nights was certainly that. The crowd were going wild for each of the presentations and so I can’t even imagine what Charlotte and Carl must have felt in those moments as I was utterly awestruck. I have never experienced anything like that before and it was something I will never ever forget the feeling of. Meeting Princess Anne was pretty amazing too, although I was so happily delirious with the whole occasion that unfortunately I can neither remember what she said to me, nor what I said in reply.

A busy end to a busy year

This is the time of year we tend to reflect on all that has gone before. One of my highlights this year was the annual open day of our partner veterinary practice, Three Counties Equine Hospital in September, which also encompassed the official launch of their new MRI (Magnetic Resonance Imaging) suite.

MRI is useful for assessing soft tissue injuries in horses and is also a valuable tool in the evaluation of bone injuries, which can be tricky to detect by other diagnostic techniques. There are various equine MRI scanners in this country currently, but the installation of this particular machine means that Three Counties have the only one in the UK capable of imaging stifles.

Their scanner is also able to provide high quality images of heads, necks, knees, hocks and distal limb injury sites such as suspensories, fetlocks and feet. When taking images from a recumbent position (pictured below), the horse receives a general anaesthetic. The scanner’s ability to image stifles means that it allows the vets to obtain pictures that they haven’t been able to previously in this country.

I really enjoyed the chance to look around the MRI suite at the open day; it was a rare opportunity to explore the facilities without the stress of accompanying a horse there! We were granted with a beautiful day, and it was great to see a good crowd turn out to watch the various demonstrations that were laid on during the day which really did offer something for everyone.

In terms of case types this year, we saw a number of horses come in following neurectomy and fasciotomy, which is essentially where a section of the deep branch of the lateral plantar nerve in the hindlimb is surgically removed to reduce pain. This is combined with transection of the connective tissue fascia covering the suspensory ligament to reduce pressure on the origin of the suspensory ligament. The technique is employed in some cases to address the symptoms of hindlimb proximal suspensory desmitis and requires a structured rehabilitation process.

We have also had a number of horses with gait abnormalities or movement dysfunction sent to us this year, and these are some of the horses that have undoubtedly been the most rewarding. Once the underlying cause of lameness had been treated, our job was to restore the horse’s normal movement pattern.

In one particular case, we had a horse who had lost her ability walk normally among other issues, having instead found it easier to jog with the hind legs. This short-stepping meant that we had to go back to the very beginning, first teaching her to walk in a true gait pattern on the long reins and treadmill, before introducing trot and canter from the ground, and gradually building up to ridden work. This mare was very much up with the horses I was most proud of this year, such was the change that we witnessed in her.

I would like to end this on a thank you: thank you to all of our horses for trying so hard to get better, to our wonderful clients for having faith in us and to all of our colleagues, vets and friends, many of whom are all three. I hope all of you have had a happy Christmas and my very best wishes for the coming year.

Fizz

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When the diagnosis of foot lameness relied upon nerve blocks and X-rays alone, conditions like navicular disease, pedal ostitis, ringbone and pyramidal disease dominated the textbooks.

Then the introduction of soft-tissue imaging using ultrasound scanners made vets realise that some of these earlier diagnoses were inaccurate and that a significant proportion of foot lameness arose from the soft tissues.

More recently, nuclear bone scanning and then magnetic resonance imaging (MRI) have opened up a world of ways in which to look inside the foot.

Both a new diagnosis and an old one have been illuminated by MRI.

Degeneration of the ligaments of the coffin joint on either side of the foot, just below the coronary band has been recognised as a specific cause of lameness.

MRI picks this up well, although a recent project by Newmarket scientists shows that the problem may be more common than even MRI reveals.

They looked at horses with apparent coffin joint ligament damage using MRI and then examined the ligaments post mortem.

Three things emerged: MRI got it right when it spotted changes in the ligaments; some lame horses had microscopic changes that did not show up on the MRI and the changes appeared to represent degenerative disease rather than traumatic injury.

And the old diagnosis? Navicular disease, in which deep ulcers develop on the back of the bone, is an excellent candidate for MRI investigation.

Other scientists have shown the correlation between MRI images and actual disease is good.

This article first appeared in Horse & Hound magazine (27 November, ’08)

Every New Year, the veterinary world looks forward to revolutions in equine healthcare; revolutions that will allow us to keep our horses fitter for longer or allow them to recover from previously untreatable conditions.

However, the medical “breakthroughs” so frequently reported by some parts of the media rarely occur in such a dramatic fashion. More commonly, researchers will work on an idea over several years and, as the work progresses, so new ideas develop and are tested. Slowly, these evolve into new diagnostic methods or treatments.

Magnetic Resonance Imaging (MRI)

For many years the diagnosis of lameness problems in horses has relied heavily upon radiography (X-rays). Many common orthopaedic diseases — including spavin, laminitis and chip fractures of bones in the knee — have well-characterised changes that can be detected on an X-ray.

But, like all diagnostic techniques, X-rays have limitations. In particular, they are rarely good at showing up changes in soft tissues, such as tendons, ligaments and cartilage that form the articular surface of joints.

MRI is an important diagnostic imaging tool in human medicine. It works by subjecting tissues to pulses from a high-powered magnetic field, which cause temporary changes in the electrical properties of cells. When the magnetic field is released, the tissues revert to their former electric state, releasing energy that can be detected. Different tissues release different amounts of energy, allowing an image to be created.

In human medicine, MRI is used for a wide range of applications, including imaging diseased joints and the spines of patients with back pain and the investigation of unusual lumps anywhere in the body.

The major limitation in developing MRI technology for the horse has been the expense and technical difficulty of getting the affected part of the animal into the imaging magnet.

However, a system has been designed specifically for horses, which allows the lower leg — the site most commonly in need of imaging for lameness problems — to be imaged while the animal stands. The “standing MRI” system eradicates the need for a general anaesthetic, and the resulting images are usually good enough for diagnosis.

MRI is very different from X-rays and ultrasound, and vets are still learning how to interpret the MRI images and how they relate to injuries and diseases that cause lameness. However, some excellent work in this area has already been done, notably at the Animal Health Trust in Newmarket.

MRI has allowed vets to identify and diagnose diseases that were previously a mystery. In particular, the causes of pain in the horse’s foot are beginning to reveal themselves and are becoming diagnosable.

This veterinary feature was first published in H&H (12 January, ’06)

After nearly five years of fund-raising and a £1 million grant from the Home of Rest for Horses, the Equine Diagnostic Unit, which includes a magnetic resonance imaging (MRI) scanner, is up and running at Cambridge University.

Prince Philip was guest of honour at the opening at the John Hickman Equine Surgical Suite at the end of last year. Since then, the clinic’s four vets, one intern, one resident and 12 students have been making use of some of the most advanced equine surgical technology in the country.

Cambridge’s MRI scanner can be used on a standing sedated horse, in contrast to some others, where the horse lies down under anaesthetic. The difference between the methods has been a subject for much discussion among vets.

Staff believe the new equipment will have a significant impact on the number and quality of referral cases they can now take on.

Surgeon Dr Jessica Kidd says: “It will really make a huge difference. We see so many kinds of cases here, not just in one area of horse care, and now we have the facilities to deal with everything, which is exciting for the staff and students.”

The Home of Rest for Horses has a strong commitment to help finance research into equine diseases, with its grants programme providing funding for the building and equipping of equine hospitals throughout the country.

Brigadier Jepson, chief executive of the Home of Rest for Horses, which is based at Speen, Buckinghamshire, says: “The Home of Rest for Horses is deeply committed to improving equine welfare and veterinary treatment.

“This new diagnostic facility at the nucleus of one of Britain’s leading veterinary universities will enable future equine veterinarians to have access to the very latest equipment and will also benefit the horse population which depends on the skills offered at this site.”

This news article was first published in Horse & Hound (3 February ’05)

Magnetic resonance imaging (MRI) is giving a whole new view of lameness problems. It could be the most important diagnostic technique of the 21st century because experts are starting to find out the truth behind conditions such as navicular syndrome.

The first MRI machine for live horses in the UK was installed at the Animal Health Trust (AHT), Newmarket three years ago. Since then, Dr Sue Dyson has scanned more than 200 horses.

“MRI has revolutionised our knowledge of foot pain, and we’re learning all the time,” says Dr Dyson. “Learning to interpret the images is a completely new skill. In each investigation there will be more than 1,000 images to examine.”

Dr Dyson explains that the reason MRI is such a valuable tool is that it enables vets to look for changes in soft tissue structures such as tendons and ligaments. It can also be used to assess areas not accessible to ultrasound imaging, in particular the foot and soft tissues inside the head, including the brain.

“We can look at changes in bone that are not evident in X-rays,” she says. “It enables us to look at all the structures and gives us dynamic information about what is going on.

“Because the images are of very thin slices, damage can be identified that would be hidden on X-rays by normal bone on either side. X-rays give a historical record of what went on in the past: MRI tells you what is happening in the bone now.”

Thanks to MRI, vets are finally getting a clearer view of navicular problems, although there is still more to learn.

“We don’t know yet what causes navicular disease. We now think there are several pathological processes taking part in the bone, so it is probably not correct to say that it is a single disease,” says Dr Dyson.

“It is astonishing what we have learned. I always believed we would find a number of soft tissue injuries in the foot, but 70% of horses believed to have navicular problems actually have soft tissue injuries, so navicular syndrome is much rarer than we thought.”

Lameness is by far the biggest reason for MRI scanning to be carried out, although there are other applications, including neurological problems, where machines such as the one at the AHT come into their own. Head scans can also be useful for teeth and sinus problems and have identified pituitary tumours in some cases.

So far, insurance companies have been willing to pay the costs of MRI scanning and have accepted the findings. However, owners must check policies carefully: you will certainly need written permission for a horse to be given a general anaesthetic for diagnostic purposes and some companies will increase the premium because of the risks involved.

It’s exciting time for vets, researchers and horse owners, because MRI work here and in the United States is creating the clearest picture yet of lameness, including previously unknown conditions.

Dr Dyson acknowledges that, as yet, treatment can’t keep pace with diagnosis, but that should change in time.

“Our diagnosis rate is very, very high but our treatment success doesn’t match that, probably because we’re dealing with some severe injuries that were not diagnosed early enough,” she says.

“I would like to think that in 10 years time we’ll have a better understanding of the causes of conditions we’re now diagnosing and a better awareness of how to treat them successfully.”

MRI facts

• MRI scanning can be used to assess soft tissues such as tendons and ligaments, as well as bone changes
• MRI is complimentary to other diagnostic procedures, such as X-ray, ultrasound and scintigraphy
• Session costs range from around £650-£1,200 depending on the type of machine, the procedures involved and whether or not the horse needs to be anaesthetised.
• There are two types of MRI machine currently in use in the UK and each has its pros and cons.
• The systems are in use at the Animal Health Trust, Newmarket, Bell Equine Veterinary Clinic and Liphook Equine Hospital. Cambridge University Veterinary School plans to have a system installed later this year

This feature was published in full in Horse & Hound’s veterinary special (22 January 04). To purchase this copy as a back issue contact (tel: 020 8532 3628).