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  Discussion on Effectivity of Ultrasound in Diagnosis of Suspensory Injury
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Member:
stevens

Posted on Friday, Nov 9, 2007 - 5:20 pm:

Wondering if anyone has data on the rates of false negatives when diagnosing suspensory injuries via ultrasound.

After 3 ultrasounds, radiographs and a bone scan my horse's lameness was finally traced to a good sized tear in his suspensory which was only visible on an MRI.

The first ultrasound was after he'd already been blocked so the vet thought there was interference as a result (air?). The second was nearly a week later with a portable unit and just couldn't get a good image of the area of interest. The third was back at the vet hospital, and appeared to get a good image but did not show the tear.

Since I lost over 1 month going through the steps to get to an MRI (and more than a couple of bucks) I'm wondering if there are any guidelines for determination of when to move to MRI faster?

Thanks!
Moderator:
DrO

Posted on Friday, Nov 9, 2007 - 6:44 pm:

Chris, though we know there are certain lesions that are not amenable to visualization by ultrasound I really don't know what might be the incidence in this location and of course it depends on your particular lesion.

The decision to pursue further diagnostics will always depend more on your goals and resources than any case presentation. Consider that for some a MRI would never be in the cards simply do to the cost.
DrO
Member:
stevens

Posted on Friday, Nov 9, 2007 - 8:39 pm:

Thanks Dr. O,

The vet that performed the MRI appeared surprised that this particular problem was not detected on any ultrasound. He was planning to ultrasound the area, now that he knew exactly where to look, to see if he could see it.

He performed a tendonoscopy(?) yesterday so I should have more information when I meet with him tomorrow am regarding the details of the lesion.

It would be wonderful if the cost of an MRI were more affordable, perhaps in the future. It's interesting how ultrasound does not appear to be as widely used in human medicine as MRI for diagnostic purposes; probably due to the availability of health insurance (but that's a topic for political section ).

I have a gut feeling that this is all going to work out and in addition I'm getting a valuable life lesson in patience.

I'm just considering the $400 I paid for major medical insurance for this horse the best investment I've ever made.

Regards,
Chris
Member:
teddyj1

Posted on Saturday, Nov 10, 2007 - 7:28 am:

Hi Chris, I truly hope you get a correct diagnosis, treatment, and cure long before your Major Medical DrOps you as mine did. I made two claims in 3 years, and that was the end of it. The were willing to keep our Mortality, but then you have to perform every diagnostic, and treatment they prescribe in order to make a claim against your Mortality, so there's a catch 22 for you.

This is a very reputable company, triple A rated who I've insured horses with for over 20 years, but they must have felt this horse was a lemon :-)

Any, best of luck, I sure know what you're going thru.
TOD
Moderator:
DrO

Posted on Saturday, Nov 10, 2007 - 7:55 am:

Let us know how the ultrasound experiment works out along with a complete description of the lesion. Of course things are much easier seen when you know where they are. On the other hand I do think the average field equine veterinarian really has problems conducting and properly interpreting a ultrasound examination. I believe this is a job for a specialist who conducts exams hourly every day and has seen and understands the wide range of normals and artifacts possible.

We are also interested in following how your case works out.
DrO
Member:
srobert

Posted on Saturday, Nov 10, 2007 - 8:05 am:

In a similar vein, what about false postives? We have a horse that came in extremely lame one morning - literally hopping. The vet ulimately diagnosed a suspensory tear via ultrasound and we followed the entire treatment protocol as described here. COmplete stall rest with eventually handwalking etc., etc. A lot of work, but you do what you have to do. Nine months or so later, my farrier found a HUGE cavern that had worked its way down the hoofwall of the lame leg. He said there must have been a doozie of an abcess there. Probably would have caused severe lameness. COincidentally just about the time the other diagnosis was made. In the back of my mind, I still wonder about whether a festering abcess was the problem and the untrasound diagnosed something because we believed it was there (the tear was very small). Horse is absolutely fine now but I still wonder about whether we treated something that wasn't really there.
Member:
stevens

Posted on Saturday, Nov 10, 2007 - 8:33 pm:

Thanks for the positive thoughts all!

Well, on the up side, it's not his suspensory after all, it's his deep digital flexor tendon. I must have misheard when originally speaking to the vet. I've read that injuries to the DDF are uncommon, so I'm apparently destined to continue down the path less traveled . On the down side, there was alot of adhesion and about 50% of the cross section of the tendon was affected, of course with tearing evident. I have the mri images on dvd so will try to find the ones of interest and post them along with the official diagnosis when I get the discharge papers. On the up side, they do both legs for a comparison and his right hind leg looks good.

Continuing on the up side, the vet indicated that the surgery went far better than he had expected. He took on the order of 2 hours for the surgery so I feel incredibly fortunate that he worked so hard to clean up the adhesions. He also extracted bone marrow from my horse's sternum and injected it into the tendon tear as stem cell treatment.

The best up side part of it all is that my horse is standing with full weight on his left hind and appears to be healing very well so far. I should be able to bring him home early next week.

Then we start the long slow road back to work. OOOOOMMMMM, I must maintain my zenlike state.

Unfortunately, there have been many emergencies at this clinic so we didn't get to do the ultrasound experiment.

TOD, I know what you mean about the insurance companies!! I initiated the claim on this injury a couple of weeks before my policy expired. I had already sent the renewal check for this year. Imagine my surprise to get a letter telling me that I had an automatic 30 day extension on my policy, but that no expenses incurred beyond the 30 days (which is tomorrow) would be considered for reimbursement. Again on the up side, I am fortunate to have worked with great vets who understood my situation and worked their schedules to get my horse in for both the MRI and surgery before my insurance was cut off. Also on the up side, I definitely got way more than my $400 cost of the major medical insurance so I can't complain. Ask me again when I pay for the follow-up MRI out of my own pocket in 9 months. At least I have time to save up.

All in all, I remain positive that he will return to work eventually.

Thanks again for thinking of us.
Moderator:
DrO

Posted on Sunday, Nov 11, 2007 - 7:28 am:

Chris injuries to the DDF in the tendon sheath are being increasingly recognized and successfully treated. The reason for this improvement is the realization that in this location many lameness causing lesions do not visualize well on US. For more on this see the Tenosynovitis subtopic in the Flexor Tendinitis article.
DrO
Member:
stevens

Posted on Sunday, Nov 11, 2007 - 11:42 am:

Dr. O.

Thanks for directing me to the article. I was so sure that we were looking at a suspensory problem that I hadn't thoroughly read anything else.

Now I feel even better!!

Thanks for such a great site.

Chris
Member:
teddyj1

Posted on Sunday, Nov 11, 2007 - 12:45 pm:

Hey Chris, that's really good news! I'm so happy to hear you have a resolution, and you and your horse can start the healing:-) Awesome !

I do feel the same way re: what I actually paid for MM and what I got in return, so I can't complain too much, but on the other hand, had I had a life threating situation, or a procedure costing ten thousand dollars I don't think I would have submitted the few thousand in claims I did.

Any way, Great news- hears to a fast recovery
TOD
Member:
stevens

Posted on Monday, Nov 12, 2007 - 7:24 am:

TOD,

How old was the horse that got DrOpped from MM? My policy does state that they will not provide it for a horse over 16.

Chris
Member:
teddyj1

Posted on Monday, Nov 12, 2007 - 9:29 am:

Morning Chris, he was DrOpped at renewal which was in May '07, he had just turned(*04/05/01) 6years old.

They never gave me a hard time about any of my claims, and were actually wonderful to work with, very supportive. In fact my agent is some one I rode and competed with in the A/O Hunter for years, even attended the same university. I think they just crunch the numbers, and decide statistically 2 claims in 3 years was too much risk.
Had I thought the initial diagnosis and treatment of EPM wouldn't resolved the issues, I think I would have just paid out of pocket, but then since he's insured, you have to report everything.

I guess what I'm saying is, if I end up getting him re insured with another company, I'll only use it for something really major like colic sugery, or where the bill could go into the $10,000+ range.

I guess I've been super lucky, with all the horses I've owned an insured in my life this is the first one that's been such a enigma, but then I never lived in a state with Lyme disease(the great imitator) :-)
Member:
stevens

Posted on Monday, Nov 12, 2007 - 9:45 am:

Hi TOD,

Interesting. They haven't DrOpped me, yet, but we'll see what happens next year. I've had one other claim on this horse; he whacked himself in turnout and needed stitches earlier this year. That bill was chump change compared to this situation! I'm hoping they just exclude his left hind leg or something like that.

Thanks for the positive thoughts.

Chris
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