In either instance, and in many others like them, seeking a second veterinary opinion can be a wise choice. Let’s explore what it means for you, your horse, and the relationship with your veterinarian.

What is a Second Opinion, Anyway?

A second opinion is when a second, independent veterinarian examines your horse after your primary vet has done so. This can be done at any point during a case work-up, from your horse’s initial diagnosis to chronic treatment plan, and is generally requested by the client.

A second opinion is slightly different than a referral, which is the term used when a general practitioner sends a case to a specialist clinic for further diagnostics, surgery, or management. Referrals are almost always requested by the primary veterinarian.

Horse owners seek second opinions for a wide range of reasons, but the most common include situations such as:

◆ When the prognosis for your horse is poor;
◆ When treatment is expensive and/or possibly long-term and prognosis is uncertain;
◆ When management is complicated/difficult;
◆ When end-of-life decisions are being considered;
◆ When you’re frustrated by a lengthy recovery time or a non-responsive recovery;
◆ When you’re confused or unsure of what’s going on with your horse or feel like you’re not being listened to.

Why Does It Feel Weird, Then?

For some, seeking a second opinion may feel uncomfortable, like sneaking around behind your vet’s back, especially if you’ve had a long, solid relationship with a specific individual. Keep in mind that vets, as medical professionals, acknowledge that second opinions are warranted and are part of the practice of veterinary medicine.

In fact, a second opinion could technically be considered part of a thorough work-up. We actually do it ourselves sometimes, calling colleagues or specialists when we feel the need for another point of view or a pair of fresh eyes. It’s also helpful in cases where we seek a more creative or innovative option, especially with complicated or chronic cases or when more traditional treatment regimens aren’t working.

If you’re experiencing anxiety over obtaining a second opinion, go through the exercise of asking yourself why you’re doing this in the first place. Identifying why you’re dissatisfied with your current vet’s plan can be a very valuable piece of information.

These can be hard questions to ask yourself, but be honest and try not to judge yourself on your responses. These answers may help you set expectations for the second opinion and help you clearly communicate what you’re looking for. Don’t let your angst or avoidance of a potentially awkward conversation prevent you from seeking the best care for your horse.

How Do You Get a Second Opinion on Your Horse’s Diagnosis?

As with most things in life, clear communication is the best approach when seeking a second opinion. You don’t have to justify yourself to your current vet, but letting her know your plan is the polite, direct, professional, and potentially mutually beneficial thing to do. If the second opinion unveils a novel treatment or other consideration, your current vet may be glad to know about it for the future.

If you use a multi-vet practice, a second opinion can be as simple as asking to see another vet. However, depending on where you live, sometimes finding another vet that serves your area can be a challenge.

Trailering to a vet school or larger clinic may not be an option for those with limited resources or who live in remote areas. Talking with other horse owners in the area may help you find another vet. Depending on the situation, you could also consider asking your current vet for a recommendation.

Once you’ve established contact with the vet who will give the second opinion, make sure she knows that’s what is happening. If it’s a complex or acute case and there are medical records, make sure the second vet has access to them, preferably before the visit. A complete history of the case is critical to obtaining a useful second opinion.

Some clinics have procedures regarding second opinions and may require that medical records be sent a specified number of days prior to the farm call. For this reason, when scheduling the second opinion, make sure the clinic knows about it ahead of time.

What Happens Next for Your Horse’s Diagnosis?

One of two options usually occurs after a second opinion: Either the second vet agrees and therefore confirms the first vet’s diagnosis and plan for your horse, or she offers other suggestions.

Of course, there are numerous shades of gray in between, and now it’s up to you to decide what to do. Here’s where those questions you asked yourself before come in handy: What were you looking for? Were the questions or concerns you had addressed? How do you feel about the situation now?

One scenario to beware of, however, is the one of endless opinions. If you find yourself jumping from vet to vet to vet trying to get an answer that you’re satisfied with, tap the brakes. Some further self-questioning and possible soul-searching is needed at this point.

Is your horse simply no longer ridable and you’re having trouble accepting that? Can you not afford the care offered? Is the care needed beyond your ability or comfort level? Again, try not to judge yourself. Sometimes roping in an independent third party, even a non-horse person, can help sort things out or identify a red flag where you’re unable to.

What Isn’t a Second Opinion?

Do you and your horse a favor; if you decide to seek a true second medical opinion, don’t settle for a shortcut. The main one to avoid is the internet. Social media is full of opinions, that’s for sure, but even well-intentioned individuals online haven’t physically examined your horse. This is a key component of a vet/client/patient relationship.

For this reason, also beware of online ads that read something like this: “Ask a vet online NOW! Free second opinions!”

Although some telemedicine by licensed veterinarians is legal and of high quality, its use depends on the situation and the state. Ultimately, you’ll end up saving time and maybe even money just going straight to a second veterinarian in your area.

In most instances, a vet and horse owner can amicably navigate a second opinion to yield a satisfying result that ultimately benefits the horse. And really, in most people’s opinion, acting in the horse’s best interest should always be the goal.

This article about second opinions for a horse’s diagnosis appeared in the August 2022 issue of Horse Illustrated magazine. Click here to subscribe!

The post Do You Need a Second Opinion for Your Horse’s Diagnosis? appeared first on Horse Illustrated Magazine.

Seeing the full picture of a horse’s body from the inside began not with a hoof, but with a woman’s hand. The accidental discovery of the radiograph in 1895 by the German physicist Wilhelm Conrad Röntgen transformed the human medical landscape. Still another century passed before advancements in equine diagnostic imaging revolutionized veterinary medicine.

Accurate, safe, and comprehensive imaging, including computed tomography (CT), magnetic resonance imaging (MRI), nuclear scintigraphy (bone scan), and the emerging positron emission tomography (PET) scan may redefine horse health today, but it has only accelerated at a rapid rate during the past 25 years.

X-Rays and Ultrasound

Early radiographs (X-rays), while groundbreaking for both human and equine medicine, rendered complications. The analog film required wet processing and often lacked sufficient image detail and quality. Delays between image development and delivery to medical professionals impeded swift diagnoses. However, with the advent of portable digital machines, equine practitioners can now capture high-quality images of bone at a horse’s stall rather than in a veterinary clinic.

Later, ultrasound technology came onto the scene, employing high-frequency sound waves to produce high-resolution, two-dimensional images of tendons and ligaments. With the ultrasound, veterinarians can assess soft-tissue injuries, colic, pregnancy, and suspicious masses, such as abscesses and tumors. Advanced speed and the accuracy of high-resolution, two-dimensional images improve physical exams.

CT and MRI

Equine diagnostic imaging rocketed to the next chapter with the introduction of CT and MRI in the 1990s, according to Katherine Garrett, DVM, Dipl. ACVS, director of diagnostic imaging at Rood and Riddle Equine Hospital in Lexington, Ky.

“The most significant change in equine diagnostic imaging is the widespread adoption of cross-sectional imaging modalities,” she says. “Their introduction allows us to make much more specific diagnoses than we could previously and understand different diseases more thoroughly.”

The difference between the traditional X-ray and a CT scanner lies in the type of image. A CT scanner examines slices of bone and soft-tissue structures on multiple planes from multiple angles and is beneficial for diagnosing cases of lameness and sinus, dental, and neurological issues.

Traditional CT scans performed on a fully anesthetized and recumbent horse presented its share of risks. The standing CT scans lower legs and images the head and neck. Because the horse only requires mild sedation, fewer complications and threats to the horse and the clinician occur.

Sarah Puchalski, DVM, Dipl. ACVR, head of Diagnostic Imaging at Palm Beach Equine Clinic in Wellington, Fla., cautions horse owners to understand how different types of image qualities vary between scanners.

“There is a difference in image quality for CT scanners, and what can and cannot be scanned,” she says. “CT is used for dentition in the skull and fracture evaluation. Soft tissue detail isn’t as good as the MRI, but the bone detail is superior.”

Soft-tissue injuries present a puzzle, especially in cases of lameness. MRI, first performed on horses in the late 1990s, benefitted from early clinical use but shot to the top of imaging modalities in the past five years. Today, MRI is considered the gold standard of diagnostic imaging for soft tissue and orthopedic injuries by using magnetic fields and radiofrequency pulses to generate images.

Puchalski notes that the particular benefit of the MRI rests in diagnosing the source of lameness.

“For example, inside the hoof capsule, you cannot evaluate tendons and ligaments,” she says. “MRI opened the door for a whole range of new injury diagnoses allowing specific target therapies.” Garrett concurs.

“With the MRI, we obtain detailed information about an entire region,” she explains. “Deep digital flexor tendon tears, navicular bone inflammation, bone bruising, and coffin joint arthritis have different treatments and prognoses. We can diagnose and treat each more specifically and hopefully have better outcomes.”

Bone Scans and PET Scans

Nuclear scintigraphy (bone scan) employs radioactive isotopes, which, when injected, emit radioactive gamma rays. A special camera documents two-dimensional images of skeletal anatomy, showing areas with increased metabolic activity.

Reactive sites light up as “hot spots” to identify sources of lameness or other injuries. Evaluating a tissue’s physiology or what is occurring inside the tissue distinguishes the bone scan from other methods.

Scintigraphy, according to Puchalski, allows a clinician not only to identify sites that may not be clinically evident but provides an opportunity to use disease-modifying agents earlier.

“Hock arthritis shows up on scintigraphy early,” she says. “Scintigraphy also allows us to evaluate the neck, back and pelvis. A higher degree of radioactivity in an area means more active bone turnover, inflammation or injury.”

Mathieu Spriet, DVM, M.S., Dipl. ACVR, Dipl. ECVDI, Dipl. ACVR-EDI, associate professor of Diagnostic Imaging at the University of California-Davis School of Veterinary Medicine, recalls the trajectory of equine imaging during his lifetime.

“When I was in graduate school in France, the only imaging modalities we had were X-ray and ultrasound,” he recalls. “In the last 25 years, we’ve had digital radiographs, CT and MRI. I’m excited to contribute another piece by bringing the PET to the table.”

PET scans add a new chapter to nuclear medicine imaging. A radioactive tracer injected in the horse shows activity in the bones and soft tissues at a molecular level by detecting “hot spots” that illuminate injury, functional change, or inflammation on images.

The defining concept of the PET scan is the distinction between functional versus structural imaging.

“With most imaging, you are looking at the size and shape of structures,” says Spriet. “When the bone looks abnormal, it’s sometimes difficult to know if it’s abnormal because something is happening right now or if there is an old injury that is not currently active.”

To perform the first equine PET scan in 2015, Spriet and his research team partnered with an engineering team from Maryland-based Brain Biosciences, a company specializing in state-of-the-art molecular brain imaging devices. A clinical program employing a modified human scanner imaged over 100 anesthetized horses with lameness issues.

Anesthesia carries its own level of risk to both the horse and the owner’s pocketbook. Four years after introducing the first scanner, a standing PET for a mildly sedated horse advanced this up-and-coming technology. With a standing PET, a clinician positions the horse’s hoof into an open doughnut-shaped ring before closing the apparatus around the leg. The ring’s detectors capture images from the hoof, but it can open automatically if the horse moves.

The radioactive isotope is injected 30-60 minutes prior to bringing the horse in to the room. In less than half an hour, a PET scan can image both feet and fetlocks. With an MRI scan, 45 minutes per foot or fetlock is necessary.

A Game-Changing Future

Kelly Tisher, DVM, a Colorado-based veterinarian and clinic partner at the Littleton Equine Medical Center, envisions future technology to scan a horse’s total circumference. According to Tisher, several companies are actively working to create and improve standing technology, including a robotic CT machine.

“We’ve been hoping there would be an advancement in technology to allow standing CT imaging, especially for a horse’s head and neck,” he says. “Head imaging for sinus, teeth, or other tumors is tricky. With the neck, we have an ultrasound and X-ray. Still, the ability to have 3D imaging and some sectional imaging and transverse imaging to learn about what different pathologies mean and what their clinical relevance is would be amazing.”

Each year, seeing the full picture of a horse’s anatomy to diagnose injury and disease matures. Century-old curiosity ignited a medical revolution, and today, veterinary researchers are casting light on more than a horse’s hoof.

This article about equine diagnostic imaging appeared in the January/February 2022 issue of Horse Illustrated magazine. Click here to subscribe!

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