From: Danielle
Dear Jessica, my horse has an injured tendon in his left front leg. When he went lame, my vet brought a portable ultrasound machine to the barn and took some "pictures" I guess you would call them, and said that it was a bad tear that would need careful management for a year before it was healed, if it did heal completely which maybe it wouldn't. He tried to tell me what I would have to do about this but all I could hear was "bad tear" and "a year to recover".
Needless to say I was devastated by hearing this news. My husband convinced me that it would be a good idea to get a second opinion from another vet, and we took my horse to a big clinic where they had a different kind of ultrasound equipment. The vet at the clinic said that the tear was not huge, but he said any kind of a tendon injury like this takes a long time to heal. So it looks as if I won't be able to ride my horse for quite some time, but what I want to know is how my regular vet could have been so wrong about the tendon damage being so bad. Or do you think that it is the fancier equipment at the big clinic that made the difference? I like my vet a lot. I have used him for eight years and I trust him. I don't want to stop trusting him just because he was wrong about my horse's tendon, but it worries me. I would like to talk to him about it, or talk to the clinic vets about it but I don't know where to start. You are so good at this kind of thing. Can you help me understand why two good vets saw two different pictures of my same horse's same leg? Thank you so much for everything you do for all of us horse owners. I don't know what I would do without you and HORSE-SENSE! Danielle
As usual, I'll remind you that I'm not a vet and don't play one on TV - or on the Internet - and can't confirm or contradict a diagnosis, offer a different prognosis, or give you specific advice about the management of your horse's injury. All I can do is give you my thoughts on the situation, and on the diagnostic use of ultrasound, and - I hope - make it easier for you to talk to your vet(s) about your horse's condition and treatment.
I don't think that either your regular vet or the clinic vet - or the ultrasound technician - would be annoyed if you asked questions about their diagnostic equipment. The differences in the pictures sound more like distinctions than serious differences - both vets saw an injury to the same tendon, and both vets told you that there would be a long period of recovery. As for the pictures themselves, it's likely that the ultrasound equipment at the vet clinic was able to offer a clearer and more accurate picture than the portable unit carried by your vet. After all, at the vet clinic, the equipment can be used under ideal conditions - the horse will be standing on a flat surface, and there will be technicians to hold the horse and set it up for the ultrasonography. Even the way the horse is standing can make a big difference to an ultrasound "picture", not just because a slight change of angle can change the appearance of a tendon on an ultrasound, but because the way the tendon appears will be affected by the horse's stance. Even the best technicians, using the best equipment, could legitimately get two different images of the same tendon in a single session, simply by having the horse's handler position the horse so that it was putting first more, and then less, weight onto the leg. And to induce the horse to shift its weight, all that's usually necessary is for the handler to move to one side or the other. Think about this. Who held the horse for the ultrasound at your barn? You, probably. A horse being ultrasounded in a barn aisle, by a vet using a portable unit, is usually held by its owner, and as long as the horse stands quietly, the owner is likely to be paying more attention to the vet and the ultrasound unit, and less attention to whether the horse is carrying an equal amount of weight on both front legs.
Ask your vet, or the vet at the clinic, or both, to go over the ultrasound images with you, point out exactly where the damage is, and explain the way in which the leg will heal. Then ask every question you can think of about YOUR role as the horse's owner/manager, and be sure that you understand the best way for you to manage your horse over the next six or nine or twelve months, what to do, what not to do, and what to watch out for. THAT's where your focus should be now.
So, to go back to your original question, it doesn't sound as though your regular vet was wrong - it sounds as though he was concerned, which is good, and as though he is conservative, which is also good. Tendon injuries can be career-threatening, and it's always best to be as careful and thorough as possible when you're dealing with them. I see no reason why you can't continue to trust your vet as you always have - all you've really said about him here is that he correctly identified the injury, which is what his portable ultrasound device was intended to help him do. To get a more precise, detailed picture of the injury, he would have needed to refer the horse to a clinic with bigger and better ultrasound equipment - which is exactly what you did. I'm going to guess that by the time you were talking to the vet at the clinic, after the second ultrasound, you had adjusted to the idea of the injury, and were able to "hear" more of what was being said. It sounds to me as though everything did everything right, so here's to better understanding all around, and a full recovery for your horse!
Jessica
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