Vet vs Farrier. Opinions, advice and NR vibes

[KP nut]

Oscar came up lame during the first few minutes of a hack the day before I went on holiday. I kept him in and then went away the next morning. He was being looked after by the YO with instructions not to hesitate to call out a vet if needed. She kept him in for 2-3 days then asked a farrier to look at him. Farrier found a crack in the sole. He cleaned it out and recommended poulticing which YO did.

YO then messaged me saying he was pretty much sound again. She kept him in a poorly paddock for a few more days, poulticed for a few more days then turned him back out.

When I came back I assumed he'd be fine. But he was still lame when trotted up. (Sound in walk). So I called the vet who said the crack was very deep and filled with dirt and grit which was forcing the crack ever wider. He recommended hot tubbing then poulticing to clean it out properly. He said the pain would just be the pressure from the dirt pressing into sensitive parts of the hoof and once it was clean he should be sound again. But he needed shoes or boots or hoof putty to prevent the hole just filling up again with dirt so he told me to speak to the farrier again. Vet reckoned he would need poulticing for a week or so then he would be sound again and he could be shod with some sort of 'special' shoe then he could be ridden again. He said there was no evidence of an abscess but that was a risk factor that could complicate things but did not seem likely.

So I spoke to the farrier who said shoes would not help and hoof needed a re-section to get air to the bugs which were anaerobic and it was at least 6 months - with a good chance of him never coming right. Which was rather a shock to hear to say the least!! I said the vet did not think there was an infection and farrier said the bugs just lived in the soil so the hoof would never heal as the bugs in the soil would basically break it down from the inside.

I will obviously speak to the vet again on Monday but in the meantime any thoughts? And if the vet just repeats his advice about shoes and my farrier does not agree with that plan, then what?

There was nothing to see on the sole of the foot immediately when he first went lame. Also he had been trimmed the day before (same farrier) and nothing picked up then either so I don't think it was just me missing it. So I don;t know how the crack formed so quickly in the first place unless there was an abcsess. Feeling sick with worry now. I've gone from 'fine' (YO) to 'a week or two then fine' (vet) to 'may never be fine' (farrier) in less than a day. It;s difficult to get my head round.

 

[MrC]

The farrier is right in saying that the bacteria that cause good infections like WLD are anaerobic so you could only put a shoe back on IF you can guarantee that it wont get back in, most resections do work but it being a sole issue resection will obviously be harder.

If it were me I would be buying some cleantrax and tubbing/sacking him for 45 mins twice/three times a week then packing the resection with antimocrobial hoof putty daily and giving it a chance. I'm not one for shoes but if they are necessary then I will do them, however I agree with the farrier that they probably won't help in this situation.

Another option could be to tub/sack with the cleantrax intensively then pack the crack with permanent hood putty that the farrier can provide, this means that once cleaned out no bugs could re enter, only problem with this is that once this stuff is in the chances of it coming back out until grown out is slim. I used it on Stella when she blew an abcess and lost a lot of her hoof wall and needed shod.

 

[hormonalmare]

KP nut, is your vet an equine-only vet? I only ask because my farrier once told me that my previous horse had a very serious hoof condition - and he told me that as a farrier he wasn't allowed to make a diagnosis, but that he was absolutely certain. My vet said the hoof was fine. Vet was used to dealing with cats, dogs and horses. I called in an equine specialist who confirmed the farrier's thoughts and said that following the initial vet's treatment plan would have resulted in almost certain loss of my horse...
I didn't take any action against the original vet, but learnt my lesson re. using an equine specialist.
With apologies if you're already using one. And sending healing vibes and good wishes for a happy outcome...

 

[KP nut]

KP nut, is your vet an equine-only vet? ...

Yes I use an equine veterinary practice. They have a great reputation locally and it was their head vet that came out to see Oscar. That's why I am so puzzled by such radically different prognoses and treatment options.

 

[carthorse]

Given that you've had such different opinions would it be possible to get your vet & farrier out together, or at least get them to talk to each other? I can't see how a crack in the sole is going to be helped by a shoe since the shoe won't cover the sole, though I guess one fitted with a pad & putty may do the job - put then you've got the risk of giving bacteria & lovely breeding ground. And a farrier can't do a resect without a vet so if that's needed they'll need to work together anyway.

I really would want them to at least talk directly to each other, so much can get misunderstood when you have to play messenger. And I hope it's not as serious as your farrier thinks.

 

[Mary Poppins]

I have limited experience of hoof problems and have only dealt with 2 abscesses myself, so my opinion is only based on limited experience and my gut instinct. I feel that your farrier is the best person to listen to. I had to google what a hoof resection is, but it makes sense to me that all the dirt and bacteria in the hoof needs to be removed and the only way to do this is to cut back the hoof and remove them manually.

Ben had a huge abscess in the winter, the farrier initially dug a small hole in his foot and a limited amount of puss drained out. However he was still lame. The farrier came back and had to dig a huge hole (about an inch across at 1cm deep) in his sole because the abscess had separated and created two channels which were heading upwards. After a second week of poulticing, the puss had gone and the hole had to be packed with cotton wool for the next 3 months until it had grown out. Luckily I could still ride him, but if the hole had been just a few cm's in the other direction then he would have had to be off work until the hoof had grown back.

My initial thoughts tell me that the bacteria in Oscars feet needs to be treated like a giant abscess. The bacteria needs to be released and drained and the only way to do this is to cut a big enough hole to remove all the nasties in there. Surely if you pack it up (like your vet suggests) and put shoes on, you are going to create more problems because you have not removed the dirt and bacteria.

As suggested above, I think you need to try and get your vet and farrier to discuss the issue, however I understand that this isn't always easy in practice. I hope that you find a way forward soon and that Oscar improves soon. x

 

[carthorse]

Digging for an abscess is nowhere near as drastic as a resect though Mary Poppins. A proper resect would have to be done with a vet present, and anything likely to involve cutting deep into the sole (a cm isn't deep unless a horse has thin soles) would probably be safest done after x-ray so they know how deep they need to go & where internal structures are. Ultimately a farrier shouldn't diagnose & if anything went wrong you'd be on dodgy ground with insurance, though having said that I'd trust a good farrier over a lot of vets!

 

[Mary Poppins]

Digging for an abscess is nowhere near as drastic as a resect though Mary Poppins. A proper resect would have to be done with a vet present, and anything likely to involve cutting deep into the sole (a cm isn't deep unless a horse has thin soles) would probably be safest done after x-ray so they know how deep they need to go & where internal structures are. Ultimately a farrier shouldn't diagnose & if anything went wrong you'd be on dodgy ground with insurance, though having said that I'd trust a good farrier over a lot of vets!

That's interesting to know. I have never heard of a resection so I don't know what I am talking about really. I thought the hole my farrier made in my horses foot was enormous, but he certainly does not have thin soles (he is a 16.1 shire x) and didn't have any ill effects. But if the vet and farrier disagree, I presume that the vet makes the final decision?

 

[carthorse]

Ultimately the final decision is the owner's, but it may mean finding a different vet. Incidentally sole depth isn't to do with size or breed - Jim was a 16.3 ID yet there were times when x-rays showed his soles to be dangerously thin, if a 1cm deep hole had been dug in them we'd have been through the sole

 

[Kite_Rider]

Lots of vibes coming Oscar's way KP Nut, can't advise and think only you can really know what the way forward is, but hopefully it's not as bad as your farrier fears. x

 

[Trewsers]

Given that you've had such different opinions would it be possible to get your vet & farrier out together, or at least get them to talk to each other? I can't see how a crack in the sole is going to be helped by a shoe since the shoe won't cover the sole, though I guess one fitted with a pad & putty may do the job - put then you've got the risk of giving bacteria & lovely breeding ground. And a farrier can't do a resect without a vet so if that's needed they'll need to work together anyway.

I really would want them to at least talk directly to each other, so much can get misunderstood when you have to play messenger. And I hope it's not as serious as your farrier thinks.

That's an excellent idea. We had to do this with J once when we had hoof problems.

 

[Skib]

If you have the best specialist equine vet, it could be a good idea to ask him or her to recommend a farrier with whom they co-operate?
It isnt a good idea to ask your own farrier to carry out work with which he disagrees.

I would really have a good discussion with the vet and tell him about the difficulty. I have doctors in the family so I would always go for the medical advice first. Provided that in general I had a vet or doctor who shared our own preferences for minimal intervention - I see carthorse has said the same while I am typing this.

The farrier too is the one who has to protect himself against bad outcomes as he is the one who does any shoeing.

 

[carthorse]

How long do you spend typing Skib? I last posted on this thread yesterday lol

 

[Jessey]

I'd be interested if the vet and farrier agree on the cause? And why it appeared so quickly?
Resection is pretty drastic, but the logic is sound in that any infection will fester in there. The vets idea of poulticing/tubbing to draw out any remaining muck and then keeping it clean seems the logical first step to me, if that fails then perhaps a resection might be the next step, i personally would opt to try the less invasive way first especially as he was improving with your YO poulticing him last week. The difficulty is keeping it clean but you could poultice to draw the dirt/gravel out, then cleantrax to kill any nasties deep in there, then find some way to keep it clean and dry, I'd be loathe to put pads on under shoes as they can't be removed to clean under them and are notorious for being a festering grounds for bugs, a shoe with a removable medical plate, with removable packing (keratex do an antimicrobial hoof putty you can apply yourself) under it would allow you to give it a good clean routinely and let air to it, or if the crack is narrow you might get away with just packing and duct tape, then after a few weeks when you are sure its clean you could have a permanent filler applied. I think I'd want the vet and farrier out together to agree the best way forward as I am sure they both have different opinions and experiances in dealing with things like this but common ground needs to be found

 

[Gimp]

This is exactly what is going on with one of posys feet, a very small crack was all that was visable but I asked Wally to look at it and behind it was a hole and the starts of WLD. It was packed with horrible little gritty bits from our newly laid roads here in the village ( grrr) It was smelly to, and like you the grit has been opening the crack further up the wall. I have been every other day picking out the hole with a shoe nail ( great for getting right in there!) and putting a spot of bleach in, It has dried up nicely now and there is no smell coming from within it. I had been packing it with cotton wool when shes been going out to avoid it refilling and trying to allow as much air as possible to it. Luckily it was caught very early, she was sound on it but become ouchy on the roads with a rider. She caught up another stone further back when out with friends on the beach last week ( also was in her carriage) but this has luckily come to nothing. Ive been trying some hoof boot son her but I really really dont like them so Im going to try front shoes on her when the farriers up in a few days. Im keeping my fingers crossed it has been resolved as far as nasties going on in the wall.

 

[Skib]

Carthorse - What happens is I sometimes write an answer on screen but dont post it. However, NR site seems to remember my draft answers so they show up in grey the next time I look at the thread. And one can retrieve them by clicking on them.
It is also true that I dont look at the time people answered and sometimes I read a thread on my phone but dont answer till I have a keyboard next morning.
But overall you are right. I spend too much time on NR (OH complains) and I think it is because I am still always wondering about horses.

 

[KP nut]

Thanks for all the replies. Vet is not in today but will ring first thing tomorrow. I have been given the numbers of 2 farriers who specialise in remedial shoeing so I will contact them both and see if they get back to me. Both are horrendously busy and as I am not one of their existing clients they may not respond particularly quickly but fingers crossed. The twins have gone the pony club camp today where they will be all week. We have been lent a pony for twin 2. (Twin 1 is on Lisa obviously) but it's not the same as going on Oscar so she is bitterly disappointed. But hopefully Oscar will heal up nicely and she can be back on her own pony before too long.

We panicked when the farrier gave such a grim prognosis, but since then I have talked to a few others on the yard and apparently he is someone who likes to intervene aggressively from day 1. He has had some bad outcomes in the past with more conservative methods. But the vet may have a more measured overview? I know from my own field how risk averse one becomes when things have gone wrong but just because it's gone wrong in the past does not mean that will happen to Oscar. I hope!

 

[KP nut]

Have spoken to vet. His view is clear: yes there are risks in trapping bugs, but there are far more risks in cutting away at the hoof wall, trying to get above the crack. In fact in his view, an abscess that forms and then tracks up and bursts through the coronary band is still less risky than anything radical at this stage. That may become necessary but is not necessary yet. And even if it were necessary, he feels it should be done in horspital using MRI imaging techniques in a sterile situation not on a farm using no more than educated guess-work about where to cut. X-rays would not be good enough to know where exactly to go.

He is phoning the farrier to see if they can agree a conservative management plan. If not I will use another farrier. I am definitely going with the vet on this one! Partly because what he says actually makes more sense to me, and partly because my preference is always for the least invasive option that is appropriate.

 

[Trewsers]

I think that sounds like the best idea kpnut. Keep us posted will you? I too like the least invasive routes whenever possible.

 

[KP nut]

OK vet has spoken to farrier and agreed a plan. So I phoned farrier and he said he'd do what the vet said but it was totally the wrong thing to do!! I said I felt very stuck between 2 radically different bits of advice from 2 highly credible people but that I was not happy for him to do work he was not confident or happy about. So I've arranged to see another farrier tonight for another opinion. Hopefully it will clarify rather than confuse me further......