The Long Slow Build To Euthanasia Part 3

There is always the question of when it's time. Barring an emergency situation, the question comes up again and again as health concerns appear. "Is it time?" and also "Is it really time?"

When the vet came for spring vaccinations I started the Osphos process. I also had Brat's teeth floated. He's been getting touch up floats twice a year for the last fifteen years, but this time I had a feeling there might be a problem. Sure enough there was an issue the float corrected. Within a couple of days Brat was much brighter and more interested in doing things with me.

Here's where the questions come again "Is it really time?" Was the tooth pain covering up the benefit of the oral supplement? Was the tooth pain sapping his energy to do anything? It's easy to say that a specific thing was the problem and the horse is fine now that's been looked after.

But that's not the case for Brat. He's more comfortable with the tooth looked after. His stifle, and all the related compensation strains are still causing him discomfort. I can see it in how he shifts his weight when standing in the barn. I see it in the care he takes standing up after a roll, the way he walks through the mud, and in the quick stop after a spring energy induced squeal and bounce. All the other concerns are still there, still valid.

I can hope the Osphos will allow him to strengthen that fragile stifle, but after two and a half years I don't think it's likely to get strong enough for another winter. I hope. Carefully and at arm's length, I hope for more time. In the mean time I take him out on a sunny day to hunt for the first green blades of spring, and I take photos as I enjoy watching him nibble.

The Long Slow Build To Euthanasia - Part 2

For each of the three horses I have euthanized I knew in the spring that I wasn't going to ask them to go through another winter. Winter is a significant challenge for horses with mobility, strength or balance issues here. We cannot control the environment for a horse as much as we can for a dog. What do you think about when deciding if another winter is a bad idea?

This is the second part of the slow build to the euthanasia decision posts.

I am pretty sure that Brat's fragile stifle has been causing him pain that has increased over the last couple of months, and explains last spring's discomfort as well. Unstable or slippery footing forces him to use his body to stabilize his feet, straining the fragile stifle. In addition to the stifle issue, Brat's left knee is getting worse. As he bends the knee when lifting his foot, he is starting to move it to the outside instead of just straight. It is more obvious at the trot, but shows increasing discomfort in the joint.

So what can I do to help?

Brat lives outside all the time. Maybe keeping him inside at night would give him enough relief from the unstable footing to keep the fragile stifle from overworking. Unfortunately his PSSM requires as much movement as possible, and his heaves would be significantly affected by being inside that much.

His paddock has very little mud, but even a little bit of slippery surface mud makes him uncomfortable. He's already on daily Previcox as a base, arthritic pain management. I did keep him in studded boots when it was icy, however everything slips in spring mud.

Last fall the Osphos for his arthritis was in full effect and he was doing well. I was careful about the footing where we rode. Brat was moved to a new paddock and loads of wood chips were put down to cover and stabilize the mud. The ground froze earlier than the year before. I don't really have a sense of how much the Osphos affected his stifle because of all the changing factors.

I do know Osphos made him overall more comfortable and have decided to repeat the treatment. It's not the best time to do it as far as determining the effect on his stifle. The drug takes a month to show effects, and during that month the ground will be drying out and putting less strain on his stifle so I won't be able to say for sure what is making him feel better. He also needs to come off Previcox for the week before and the week after Osphos - not ideal when he's already very uncomfortable.

But. The sooner it's done, the sooner he gets the relief from the Osphos. If, big if because I don't know, if he's not going to see another winter I want his last months to be as comfortable as possible. Osphos now will get us to September or October (5-6 months). By which time I should have a better idea of how it's affecting his stifle, and how his knee is doing, giving me more information to make the decision.

As it stands right now, if nothing changes I can't let him suffer through another winter. We've got some things to try, and a lot can happen in six months. The foundation for the decision is there with a clear understanding of what I'm going to be looking for over the summer. Letting Brat go will be the most difficult thing I've ever had to do, but his quality of life is the priority.

The Long Slow Build To Euthanasia - Part 1

I'm down to one horse now.  My third horse is the last of the four horses I have owned.  He's 27 this year, and the last couple of years have had some health challenges in addition to his long term issues of heaves, PSSM and PPID (aka Cushings).  These three are still well managed through a precarious balancing act of care, but it won't take much to bring the whole thing down. 

I started this blog years ago to provide some insight around making the decision to euthanize my horse, hoping that people who needed it would find some support as it wasn't something widely discussed at the time.  There is more discussion around quality of life these days.  There are also many more veterinary options for care, resulting in many more questions about how much we should do, and when should we say enough. It's not a decision made in a short period of time. Considering the factors, options, the individual horse, and our own situation occurs over a long period of time.  Barring some catastrophic emergency, the decision to euthanize builds slowly over weeks, or months, or sometimes years.

This is the first of several posts looking at that slow build.

Here I am again. It is spring, and I'm evaluating how my senior horse handled the winter. We have real winter here - snow, ice, and freezing temperatures for months. This creates problems for horses with mobility, strength, and balance issues. Brat has several mobility concerns.

On September 30, 2022 Brat injured his stifle. He spent the winter healing and was doing very well when we got over an inch of rain in one weekend late April 2023.  The rain turned the spring mud to sucking mud, and Brat tweaked his stifle again. Over the next year he went through periods of healing and setbacks, not helped by a series of abscesses that followed a bout of cellulitis. I couldn't tell if the lameness was caused by the stifle or an abscess.

In the summer of 2024, between abscesses, he was close to sound. I realized that he was less sound on days where the footing was a little slippery. After consulting with the vet, we decided that this was probably as good as the stifle was going to get, and some strengthening work would benefit.  Brat was feeling good as he happily went out for walking with a little bit of trot trail rides. It was during those rides that I noticed he was dragging his left front toe as he swung that foot forward. He was losing some range of motion in the left knee.

Xrays showed some very minor arthritis of the sort one would expect a 26 year old horse to have. The vet recommended Osphos as a whole body arthritis treatment as an alternative to just injecting the knee.  After doing some research I opted to try it.  Osphos takes a month to show effects, and it can be done every six months.  Brat got his Osphos injection in early August, and in September I felt he was more comfortable.  He did well through the fall, but in the new year I thought he was losing the benefit.

Five months out of something that can be done every six months, and takes a month to take effect seemed like a questionable benefit.  I talked to the vet about alternatives and ended up trialing an oral joint supplement for six weeks. I didn't see any benefits, and in the third week Brat walked away from me in the paddock twice. He usually comes unless the footing is bad or he's not feeling good, in which case he stands and waits for me to go to him.

Exercise is a critical part of the management for Brat's PSSM and heaves. He wasn't really interested in going for exercise walks, and I had to give a lot of encouragement to keep him moving at a reasonable pace. He was increasingly uncomfortable about picking up his hind feet, and standing in the barn - symptoms I had blamed on constant abscesses last spring. Now I begin to consider if perhaps it was, and is, the stifle.

Snow, ice and mud are not particularly stable footing. As last fall's rides showed, he is more uncomfortable when he must stabilize his feet with his body - specifically the fragile stifle.  I noticed increasing trouble in January, three months ago.  April is typically varying degrees of muddy, making a total of four months with a noticeable degree of pain. There will be mud, ice and snow again in the fall. The question looms large. Have we reached the end of the line?

The Promise of "How Things Should Be"

 

Photo by Wendy Webb Photography

Very few of my best horse memories are of competitive events, but this one weekend with my fourth horse, Rory, was special. It was my favourite endurance ride, not that I'd done very many by then. It was the closest ride, and one for which I did a lot of pre-ride volunteering.

The previous ride had been my first attempt at doing two 25 mile rides in two days,  and I had pulled out halfway through the second day because Rory was tired. That had been a mostly flat ground ride, and as this one was in the big hills I thought two 25s would be too much that soon, but I wanted to do one. Plus there was a 13 mile night, training ride that I really wanted to do, and I wanted to ride both days.

I ended up entering the Saturday 12 mile Set Speed (which is graded based on time and final heart rate - no placings), Saturday night's 13 mile training ride, and Sunday's 12 mile Set Speed.

For Saturday's Set Speed I set a goal of achieving a Grade One finish. I rode alone, and my horse was super. Rory did everything right, and managed to pass the scary cows without dancing. As we approached the end of the second last field on the last loop, I heard thundering hooves behind us. I looked back and saw a loose horse cantering along. I decided to run down to the corner where the track went out of the field, dismount and turn to face the loose horse. Rory let me catch the loose horse and lead both back along the trail to where I found the rider (who had already dismounted before her horse bolted). Despite the delay, we got our Grade One finish.

The night training ride was a great experience. Rory was really good, and we traded off leading, following, and being tail with the other two riders. The loop used for the night ride shared trail with the loop I had ridden twice for the Set Speed earlier in the day. It was amazing how the horses went over the rough parts without a stumble or hesitation. I hadn't previously done much night riding with Rory, yet he took to it as if it were an everyday occurrence. As a training ride there was no grade or placing, but we did pass the vet with top marks.

Sunday I was the sponsor (responsible adult in Endurance) of a first time Junior rider. She was good company and eager to learn all she could. We had a good ride despite a rainy first loop. The sun came out for the second time round. Rory didn't put a foot wrong all day. 

This weekend is a special memory not because of the successes in each event,  but because Rory had had so many challenges in getting to the point of being capable of doing this sort of thing at all. It felt like we had finally got things figured out, our partnership was solid, and were ready to move forward. 

It was also the last competition we ever did. The wheels fell off for good a few months later, then the neurological diagnosis came the following year, specifically Wobblers six months after that, and euthanasia last fall. The promise of that weekend was never realized, and it remains a treasured memory of how things should have been. 

The Limits of Veterinary Care

 There comes a time in a horse's life when the limits on veterinary care, both dollars and treatments, will change.  Depending on when you got the horse, this may occur more than once.

My super horse, Brat, has been with me since he was only a few days old. At one point when he was in his prime, I was going away for a few days, and I wrote care limit letters to my barn owners and vet for him and Tommy (the horse who inspired this blog).  The letters were to provide authorization for treatment in the event they couldn't reach me.  At that time Tommy was retired and at the point of pain management. His letter had a lower dollar amount and a "no hospital" directive. Brat's letter had a much higher dollar amount and permission to take him to the hospital if the odds favoured a good outcome.

Brat has a few well managed health issues, and is still in very good shape for his age. It's only in the last year that I've been seeing the indications that he is a senior horse. As much as I would like him to live for ever, we're at the point of having perhaps a handful of years left.

He colicked in December 2023.  A month ago, as I write this. I caught it early and had called the vet about an hour after he stopped eating. It seemed a fairly straight forward gas colic, and he hadn't had time to develop secondary issues like dehydration. But he was still uncomfortable ten hours later, and still showing the tension line of pain on his belly the next morning.  We had the vet out a second time, and I had to tell them that Brat was not a surgical candidate.  If he had to go to the vet hospital for treatment, we would be euthanizing him.

It was a heart stopping, gut wrenching realization that my Super Brat is no longer young.

As our horses age we learn manage the issues that develop.  It is easy to add one more little thing, and then another, until we have a carefully balanced house of cards.  As long as nothing upsets it, we can keep things going. Brat has three chronic health issues, and has been healing a stifle injury and reinjury for over a year. Stall rest would upset the management of two of his chronic issues, and not do the stifle any good either.

It is important to regularly assess our horse's management and health, and think not just about what our dollar limit is on emergency care, but also on how current health issues and management would be affected by various treatments. While not a pleasant task, it is easier than trying to make emotionally charged decisions in the middle of a crisis. Knowing those limitations can help with treatment during an emergency.  I had considered giving Brat some anti gas and waiting for an hour or so to see how he did, but because of his age and not being a surgical candidate, I decided to call the vet sooner than later.

We did get the colic resolved and cause addressed, and Brat is back to normal.  And I realize that it's past time to update his veterinary care authorization letter.

The Decision Doesn't Get Any Easier

Fourteen years later I once again have a horse who won't see another winter. He is the third horse I have had to make the decision for. It's not easier.

I started this blog at a time when we were starting to talk about euthanasia openly. The dominant response at the time was "you should try..." as the socially acceptable thing was to do absolutely everything you could to keep the animal alive as long as possible. Now we talk more about quality of life and recognize that there is a point at which treatments only prolong suffering. This makes it easier to talk about, but no easier to decide. 

I wrote this blog. I made those decisions. I keep the lessons around endings close. I reread that blog post. I trust myself to know my horse, and I make the decision.

And I cry. I feel guilty for not being able to fix him. I feel cheated out of the future we were supposed to have (he's fifteen). I feel alone as I stand on the edge and see what precious part of my life I am about to lose. I question myself, even as I know I'm making the right decision. I desperately hope nothing catastrophic happens before that chosen end date. I hide my sorrow at impending loss and try to do things he likes.

Yes, I still feel all of that even with previous experiences. So I can say to you - Trust yourself. You do know.

When do you know it’s time? The toughest decision of all

It's a subject that has come up recently on a couple of different horse bulletin boards that I frequent.  I had to make the euthanasia decision for my first horse and I thought a lot about it afterwards.  The questions and self doubt don't stop just because the horse is gone.  Our society tends to not talk about such things, and unless you're close to someone who's had to go through it, the average person really is on their own the first time. It's too easy to second guess ourselves and listen to people who "ought to know" that first time. There is a culture of trying to help preserve life and the automatic reaction of others is "it can't be that bad" and "have you tried such and such?" and in our inexperience we wait, or try something else.  Over time as I shared my experience the knowledge was distilled into three key ideas, with a few extra bits of advice.  I wrote it down and edited it over time, and when my second horse approached the end I came back to these lessons that my first horse taught me.  For this reason I now include the revised version in my second horse's blog.

I want to let my friends go on before they are enduring existence. Before every bone is showing. Before the depression or drug stupor takes over their life. Before they spend grinding weeks suffering pain and discomfort. I want them to leave knowing the sun on their bodies, the breath of warm air in their lungs, the half dance step of delight at going out or meeting up with a buddy. Knowing that I love them.


We all secretly want to walk out in the field one day (far in the future) and find our beloved equine flat out and already gone, but realistically that's not going to happen for most of us. We're going to have to make the hard decision. Long before I had my own horse those stories printed in the horse magazines about the heroic efforts people made to prolong the life of their aged equine, and the description of their descent and ultimate hanging-on-by-a-thread condition before the owner had the guts to admit that it was time to let go always made me sad and angry (for the horse's sake). I felt it was cruel to prolong a life with no real hope of recovery or any quality, and promised my first horse (when I bought him) that when it was his time I would give him the last summer and then let him go.

First of all - this is the biggest one - TRUST YOURSELF! YOU know your horse better than anyone else, YOU can see the little things sooner, better than ANYONE else in the world. Don't close your eyes; look, track, judge every single day you see your horse. What defines your horse's personality and characterizes your interactions? Watch for the slightest changes - not once, but if they are growing more frequent or worse, or you realize that X has become the new 'norm' it is up to you to work out why and what you can do to help.

Second - be real for your horse's sake. If she/he is not comfortable for any period and the vet offers something, be direct and upfront and ask the hard questions. Will it improve back to where it was? Will this treatment heal the problem? Will it just mask the problem? Will it create more problems? Will this be an ongoing always treatment? Can I afford it? Then go away and face the answers. Do you just want to prolong your horse's life because "I'm not ready yet"? Believe me, you never will be. Are you improving the quality of his/her life, or just increasing the time spent suffering?

One of my second horse's final gifts came to me about a month before he was euthanized in October 2009. The euthanasia had been generally planned for several months, and I was doing the usual agonizing even though I knew without a doubt it was the right time (thank you first horse).  I finally realized that while the answer to the question "could I keep him going through another winter or several?" is a definite yes, that is the wrong question. The real question needs to be "Should I?" and to that question I must reluctantly answer "no". He definitely deserves better than being forced to endure life simply because I'm not ready to let him go. I never will be ready.

Third - look for and project the factors that make your horse less comfortable. In my case my first horse had two months where he wasn't doing well in his last spring. Factors - weather, temperature. Projection - autumn, spring, even a warm spell during the winter. Two months is an awfully long time especially if you can see it is likely to repeat too often.

A good relationship with your vet is a real help. Mine simply asked me "Are you sure?" when I made the appointment for my first horse, and that was it. Six months later he told me that he doesn't like euthanasia and even tries to find new homes for animals if he doesn't feel they need it - but when I said it was time, he had no doubt that I did know. You don't want to be arguing with your vet at this time.

Close your ears to all your well-meaning friends who can't believe you are doing it and did you try such and such - you know your horse, you ARE right. You will question yourself every day, but keep going back to the first thing.

Make the necessary plans early - whether you are going to go spoil your horse, stuff him full of carrots and then go away, leaving him tied to the wash rack before the vet comes, or stay through the whole ordeal (or anything in between) you won't be able to do anything else on the day.

We cannot control our horses’ environments the same way we can for our small housepets. Dogs and cats can be kept in a warm environment, with limited forays into the cold. We can medicate them more easily and frequently. We can feed them special diets more easily. Horses by their very size and nature limit how much we can do for them. These limitations must be acknowledged and accepted when we decide on treatments for our horses’ ailments.