I would really appreciate any advice or thoughts. Apologies in advance for the long post:-)(I think I have just broken this groups record for the longest ever post:-)) I took my young warmblood mare to a well-known vet in Johannesburg late last year as she was sporadically uneven on her left fore. I appreciate vets cannot give a time for a consult as they are always unexpected delays. When I made the appointment however his secretary advised that if I bring the mare in at a particular time on a particular day, he would definitely be there - important to me as I wanted to be there when he examined and I live 45 minutes away. I called before I left and was advised he would be there, I arrived forty five minutes later to be told that this is his day with the race horses, and they could not anticipate what time he would return. I could not wait indefinitely so I left the mare. A little frustrating as they had lied to me on the phone - he is at the racehorses this day every week. On admission form I authorised that he do all tests pursuant to reaching a diagnosis. I advised on the admission form that the mare had displayed 1/5 lameness 3 months earlier and the vet had diagnosed a twisted coffin. The vet had advised against x-raying / scanning at that stage given the mild nature of the lameness. Whilst she was sound after 5 days of bute and rest, she had, since then, still had the odd uneven step. The vet called me later that afternoon to say he had performed nerve blocks and x-rayed. He advised he (my mare) had high ringbone. I expressed shock and the vets response was that it is not all that unusual that an aged horse, with poor conformation that has raced have ringbone - he sees it often. I pointed out that as stated on the admission form, she is a warmblood (presumably never raced:-)) and has near perfect conformation (not a likely candidate for RB) and is five years old. His response oh she is only 5? Again, I was fairly frustrated. I asked him to confirm that based on his x-rays there were no changes to the navicular and that there are no changes to the coffin as I understand ringbone in coffin to be career -ending and has a far worse prognosis than high ringbone. He replied that there were no changes to navicular based on his x-rays. He said the coffin was completely clean - if there were changes to the coffin, he would immediately write her off. He went on to say he was optimistic about her long-term prognosis as a competitive eventer as he had seen A-grade SJ with far worse and this could probably be managed. We agreed to start with cortosoid injections and appropriate shoeing. When I collected the mare he was not there and his assistant vet advised that a shot of Legend would help which I authorised. She also said I should consider Tildren as a treatment option. I went to reception to pay the R7 500.00 and the receptionist said she hadnt prepared the bill yet and she would send it to me. I wasnt entirely happy with the vets diagnosis (given that he appeared not to have taken into account things that I believe to be fairly relevant when looking at RB and reaching a holistic diagnosis). I took her to Onderstepoort to be re-examined and re- x-rayed. The vet there (a Dr. Mahne)(who I highly recommend) lunged her in a tight circle on the hard and within 2 circles he indicated that whilst there may indeed be problems with the pastern, the ultimate problem was lower down. She blocked sound when he nerve blocked the coffin. X-rays taken and revealed the problems to the pastern as identified by the previous vet and, in addition, articulating ringbone in the coffin and changes to the navicular bone. Prognosis very poor. Paid the 8k bill. I wrote to the first vet advising of Dr. Mahnes different diagnosis that had contradicted what he had said to me and written in his report. His response to me was very strange. He said that he had met my stable manager when she dropped the mare off and that person had been unable to give her history on the horse. He then examined the horse with my assistant. They both tried to contact me as my assistant was fairly useless and had no history of the horse. Neither of them could contact me so it was difficult to do an examination. He said he performed the tests based on sound diagnostic principles and he stood by his diagnosis and that the other vet is wrong. I e-mailed him back pointing out I do not have a stable manager (I keep my horses at home). Nor do I have an assistant. I dropped the mare off and he was not there at the time. I had included a detailed report of her medical history on the admission form and I could show from my cell records he had not tried to call me. I asked for an explanation as to why Dr. Mahne had picked up the coffin and navicular problems when he hadnt. The e-mails flew back and forth and eventually he requested a meeting. He has consistently advised me (both in e-mail and telephonically) that he has the mares best interests at heart and was angered that I had sought advice from another vet as he has 30 years of experience, the most advanced x-rays and he is not wrong. I was therefore surprised he didnt request that I bring the mare with so we could get to the bottom of the differing diagnoses. He also didnt request that I bring Dr. Mahnes x-rays with - again (to me at least) a clear indication he did not have the mares best interests at heart - the meeting was purely to discuss the bill. Our meeting was vey strange. I introduced myself and he said he had met me and my stable manager before. I pointed out I had never met him and I have no stable manager. He was fairly belligerent and told me to bring on all the vets and he would fight them all tooth and nail as he knew he was correct and they were wrong. He went on to say that the RB in the pastern he had identified carried a very poor prognosis as the changes are substantial and even if there were changes to the coffin he would have written the mare off based on the pastern problems alone. I asked him why he had then been so optimistic when we initially spoke after the consultation - his response was that I am always optimistic. In the matter of two sentences he contradicted himself completely. We then looked at his x-rays. He saw on his x-rays there were changes to the navicular but he hadnt noticed them before and they were too mild to mention. He maintained the coffin was completely clean you do not get a cleaner coffin than this and said he would fight any vet who said otherwise. I questioned the efficacy of a general Legend shot - he conceded that a Legend shot would be fairly useless in this case. I questioned the recommendation of Tildren as a treatment option for RB. Again he conceded that Tildren would be an inappropriate treatment and his junior vet should have rather recommended I consider IRAP and shockwave. Following our meeting I sent him the x-rays performed by Dr. Mahne and Dr. Mahnes report. He conceded that on these x-rays there were indeed changes to the coffin and the changes to the navicular were clearer. I advised him that I was struggling to bring myself to pay him as his examination and diagnosis missed several material things. I said to him we had entered a contract of sorts - I was under an obligation to ensure that I empowered him (with the mares medical history and authorising all tests he deemed necessary) to make a correct diagnosis. His obligation was to reach a correct diagnosis based on the tests he had performed. Once he had done this, I was under an obligation to pay. He was also under an obligation to act professionally - at the very least on examination take note of the age, breed and conformation of the horse as these are material to RB and reaching a correct diagnosis. Had he been professional and known the basics from the outset I probably would have seen no need to consult with another vet who I then paid R8000.00 to. The vet used what I think is a fairly inappropriate analogy if you go to a doctor and ask the doctor to look at your breasts and he tells you everything looks great and it subsequently transpires that there is a problem, you still have to pay the doctor. His argument appears to be that his only obligation is to perform the tests and not to correctly analyse the results. Surely this cant be right? Any thoughts on whether I should just pay and put it behind me or whether I should fight it. I am tempted to report his conduct to the veterinary council as I really think he has bought the profession into disrepute. Any advice / experiences much appreciated.
Posted on: Wed, 12 Mar 2014 13:13:11 +0000
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