Tuesday, December 7, 2010

Second Opinion Ultrasound

The vet I called to get a second opinion on Lilly's leg was out this morning.  She's actually very nice and I've worked with her before, but when I moved to a new barn some time ago they used a different practice and it was easier just to switch.  She also has a lovely SPB gelding that she shows and has beat me once before in showmanship with him.  :) 

The first thing I did was fill her in about the saga that is Lilly's leg.  I mentioned the misdiagnosis and how I was riding her injured and how her leg very recently swelled up again (showing her the picture on my phone).  She wanted to take her to the arena and watch her jog.  I usually longe Lilly because that's just how I am, but Dr T's assistant insisted that she longe so I could stand with the vet and watch.  Lilly was such a good girl...  despite the fact that it was 27 degrees and windy outside, she jogged around quite lady-like.  She wasn't lame at all, and even after a flex test trotted off just fine.  The swelling is also gone in her leg, so we didn't have much to work with.  Which was good, of course, in the grand scheme of things!

Dr T said we really had 2 options.  Either I could go ahead and start riding again and see what happens, or we could ultrasound today and see if there's anything still going on.  She said the injury area felt cold and tight, and since Lilly was sound, we could take the wait and see approach and I could call her if anything went wrong after starting her back under saddle.

I am so sick and tired of the wait and see that I could scream!

So we did the ultrasound.

She asked how Lilly did during ultrasounds and if we needed to sedate her.  I told her Lilly is an old pro at this unfortunately and she would be just fine.  True to form, she got very sleepy about half way through and fell asleep in the assistant's arms.  She's so sweet...

Dr T had been scanning for about 3 seconds and right away started pointing out problems.  "See this right here...  and this...  and then this whole area here?"  She very clearly still has some issues in her check ligament.  It looks very mottled and not very fibrous.  Her ultrasound picture was a thousand times better than the other vet's machine, and it was very easy for me to see the areas she was pointing out.  Dr T even showed me a spot on Lilly's DDFT that was probably causing issues, and said it was a little ironic that she really does have an issue there.  She showed me the difference between what the scar tissue looked like, and then what we were dealing with in regards to the mottling.  A much different bedside manner that I can appreciate.

So Lilly definitely still has quite a bit of healing to do.  Dr T said that if I had started riding her she would have expected a call from me within 2 weeks about Lilly being lame again.  There's that much still going on.  So why in the world my other vet has done numerous ultrasounds with the same response, "everything looks good", I have no idea.  Is it because of the not-so-good ultrasound machine?  I mean, they're looking at the same thing.

Dr T suggested shock wave therapy as the best course of treatment.  She said she's had good luck with it, even on horses with giant holes in their tendons.  They're back to full work and doing really well.  She said Lilly's ligament needs help to heal the rest of the way because we can can safely say resting her hasn't helped, so it's time to move on to something else. 

She said she probably would have suggested SWT as the best treatment plan from the start, rather than the platelet rich plasma treatment I did in November.  She said it helps keeps scar tissue from forming and in Lilly's case can help reduce the amount that's there already.  So it is possible that the bump on her leg will decrease in size.

So time to spend some more money on Lilly, but hopefully this time the treatment will finally get her healed up and back to a normal show pony.  I'm just glad I have the answer I was looking for a plan to focus on.  Since Lilly can't behave herself in the pasture, she's banished back to stall rest for the next 6-8 weeks.  The SWT treatments have to be done 2 weeks apart, 3 separate times, so I need to get with the office and set up the appointments and try to work around Christmas and New Years as best as we can.  Hopefully it won't have to wait until after the holidays.

Now the question becomes whether or not this is residual from the original injury, OR if this is what happened when the abscess and all that mess happened in August. Before August she was back to normal work and only since the abscess started having all these other issues. I'll never know the answer, but I'll obsess over it nonetheless.

I'm pretty upset because I feel like I've wasted a lot of time on this. 

Thursday morning my other vet will be out to adjust a horse at the farm.  She'll be out during the time I'll be there taking care of my two and Baby.  I just know she's going to ask about Lilly...  should I be honest and tell her I got a second opinion and we're doing SWT?  For some reason I feel bad about going to someone else for an opinion and I'm not sure what I should say when I see her.


  1. Wow. You must have a lot of mixed emotions. I'm so glad you got a second opinion. Chuck's cow horse Rooster had SWT with great results. That horse works hard, no problem. Gosh, I'm so sorry Lilly has to go back to stall rest. It's stressful for both of you, I'm sure.

  2. As far as telling the other vet? I wouldn't volunteer the information like "oh hey, other vet, guess what?" but I think if she asks you can tell her you felt it was time to get a second opinion and perhaps even that you were impressed with the other vets technology and how clearly you could see the tendons and their issues. She can't really be surprised that you got a second opinion after she knew she misdiagnosed. Not an easy conversation, but once you get it over with it won't be a big deal, I think. Much better than evading if you are asked how Lilly is doing, IMHO.

  3. Glad you got that second opinion. Vets vary in their abilities and also in their opinions. Don't worry now about what you did or didn't do in the past - it's the past now - just focus on what you want/need to do in the present for her. Sounds like you've got a good route to ultimate soundness, which is very good news.

  4. Yeah, don't beat yourself up. You'll spill a lot of milk in life, and you can't go back, so get over. Sucks, yes. Learn, yes.

    And if the vet asks, tell her the truth: you were not satisfied and looked for another set of eyes. That's life in the world of vets (or anyone who hangs a shingle).

    Be strong. Your horses need that.

  5. I do have quite a few emotions running around, Terry... I'm glad I can look forward and will hope and pray that the SWT is all we need to get her better finally! I'm glad you personally know a horse who has had the treatment with good results.

    SillyPony, that sounds good. I didn't want to lie to her because that just seems silly. I know she'll ask about Lilly so I guess I'll just have to tell her that I got a second opinion and am moving forward with a different treatment plan... I'm just not very good with that stuff.

    Thanks, Kate. I sure hope we're finally moving in the right direction. I'll be thrilled with any progress at all because it seems like we've just been in this holding pattern forever. We're at 13 months now since the original injury.

  6. Thanks, Cedar... This has definitely been a learning process. I hope Lilly knows I'm doing the best I can for her.

    I tend to be the one hiding in the corner as opposed to actually confronting people, and Thursday will not be comfortable for me at all. I don't have anything to be ashamed of, and I'm not the first person to get a second opinion, so I don't know why I feel so bad about telling her what the plan is.

  7. I'm sorry to hear that Lily is still suffering from those darn issues. Maybe now that you have this difinitive diagnosis, you can get her the treatment she may need to nip this in the butt once and for all....again, I'm sorry - I can't imagine how frustrating this is for both you and Lily. :(

  8. Wow, its amazing how much difference an ultrasound machine makes. Hoping that the SWT works :)

  9. I'm glad you got a second opinion, and you have nothing to hide from your original vet. Just be honest and straightforward (not accusatory) and if she's a professional, she'll understand. She may not like it, but she should understand.

    I did have a run-in with a vet who did not appreciate my going to get a second opinion. In fact, he cursed and yelled at me over the phone. I didn't like his manner much to being with, but that pretty much sealed the deal. If your vet gets offended and nasty about you getting a second opinion, you probably shouldn't use that vet. Certainly the guy I had a run-in with doesn't see my horses any more. :)

  10. Well, poop. But I am glad you decided to get a second opinion and saw all that before you started riding her again! Gosh, thats scary.

  11. Thanks, JJ. Hopefully this will be the treatment plan that works and I can get back to riding!

    Justaplainsam, that's right... and the last machine they used was even "new" because the vet was having a heck of a time figuring out how to get it to take pictures.

    Jenj, wow! I guess that's what I was afraid of. I'd still like to use one of the vets from that practice for my vaccines because I really like her, and I'm afraid I'll burn the bridge and they'll delete me from the computer or something.

    I can't imagine being cussed at though... yikes!

    Thanks, Britnie!! I'm glad Lilly's tendon swelled up on me or I would have been riding her already... scary stuff indeed!