Horses’ quality of life… and when to call it a day - Veterinary Practice
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InFocus

Horses’ quality of life… and when to call it a day

As vets we must help owners through the difficult time that is the end of their horse’s life by providing an objective assessment which takes into account the horse’s emotional value to the owner while also prioritising the physical evidence of ageing

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Winter is a bleak time for everyone, or so it seems. Horses probably don’t struggle as much as we do, but it is undeniably a time of reduced activity for most, with more confinement to stables and less availability of grass. They perhaps experience less interaction with owners, reduced time socialising and definitely more mud and inclement weather. If you’re young and fit this is unlikely to prove too much of an issue, but if you’re old, arthritic and already nearing the end of life, the winter is likely to be your least favourite season. As such, many owners of ageing horses reflect on this suitably in the autumn and sometimes make the bold decision to “call it a day” when the best of the summer has passed. But when is the right time? How do we know? When an owner asks for advice, what can we, as vets, tell them?

The truth is we can’t be sure. Without the evidence of a rapidly progressing disease or overt suffering to take these decisions out of our hands, it is a hard call to make for anyone involved, not least the person who is emotionally invested in the animal and wants nothing more than to see them for one more day. In recent years, behaviourists and researchers have been making great strides in understanding how quality of life can be measured, by looking for signs indicative of positive and negative mental states. To put it crudely, over time the positive experiences must outweigh the negative ones. This sounds simple enough but the nuances of behaviours and how they are interpreted can be very much misinterpreted by owners who are already biased by their very relationship. A gradual decline in an elderly horse can be almost undetectable to the daily caregiver, whereas the periodic attendance by a vet may provide a more objective assessment that can still take into account the horse’s emotional value to the owner while also prioritising the physical evidence demonstrated by the horse.

Periodic attendance by a vet may provide a more objective assessment that can still take into account the horse’s emotional value to the owner while also prioritising the physical evidence demonstrated by the horse

As a general practitioner in the equine field, it is not uncommon for me to find myself broaching the subject with an owner uninvited. Interestingly, I rarely do this consciously but more as a natural progression when discussing changes in the horse which were not previously detected by the owner. Changes in body condition, deterioration in a historically low-grade lameness, subtle signs of dysphagia and alterations in demeanour are all common triggers for this conversation. It is sometimes difficult, and predictably emotional, although I try to gauge reactions in order to appropriately steer the conversation further. What may have started as a short vaccination visit can sometimes turn into a much longer counselling session for the owner, with less clinical knowledge imparted and more emotional support being offered. Rarely are these conversations a complete shock; in fact, nearly always the owners admit to having buried these thoughts or feelings for fear of the unavoidable decision making that must ensue. In these cases, the owners are nearly always grateful for that process having been started and they express their gratitude at having been helped through this tough but inescapable part of horse ownership.

Sometimes there are cases where, through ignorance or denial, the owner is adamant the horse is “happy”, “coping”, “still eating their food”, and so on. They refute any suggestion that the horse’s quality of life and freedom from pain and discomfort are in question. These are harder situations, and may require a more gradual approach, but I try to avoid losing contact if at all possible. And depending on the severity of my concerns, I try to suggest following up or trying suitable forms of palliative care in order to soften the process and allow time for acceptance, with the caveat that we are only ever “buying time” and not putting off the inevitable. As such, the journey to prepare for end of life begins there, regardless of whether it should have started some time ago.

Depending on the severity of my concerns, I try to suggest following up or trying suitable forms of palliative care in order to soften the process and allow time for acceptance, with the caveat that we are only ever “buying time” and not putting off the inevitable

By far the hardest cases are those where any veterinary involvement has undoubtedly come too late. I am grateful to say that among my cohort of horse-owning clients, these occasions are few and far between, but they stick with me for that reason. One was a skeletal family pony, kept in a makeshift stable at the back of a garden, far away from onlookers who may have otherwise alerted an equine charity or local practice to the need for attendance. The pony had been a loyal servant, teaching one generation to drive and two generations to ride, and had long since lost its companion to laminitis. It was well rugged and had a clean, deep bed but days, if not weeks, of uneaten hay lay in the corner of the stable. I was called to see it after the owner had seen no improvement in its colic for over 24 hours. The sorry state that I was met with broke my heart. The owners had clearly meant well, but I can only presume that lying flat out, sweating and paddling its hind legs in several piles of old poo were not unusual, after they offered me the hope that it had normally always managed to get itself up eventually. As I peeled back the sweat-soaked rug the skin and bone revealed sores that suggested this wasn’t the first time for a long time. A very brief clinical exam confirmed this pony was nearing the end already, and I discussed the only option we had. They were understandably upset and rallied the generations of family as quickly as they could to say goodbye, but I had to expedite the end before they could all arrive. This once “horsey family” had presumably lived by the ill-informed belief that nature would run its course. Planning for end of life had not been on their radar at all, and it saddens me that this was how their much-loved and prized family pony came to an end.

This story is not dissimilar to another case, this time a retired champion showjumper that I came to see on a family’s estate after the “groom” (who was not experienced with horses) had found it “covered in maggots behind”. The poor mare, kept alone in a pasture at the furthest point from the family’s house, out of view, was emaciated and covered in sores, and she had clearly prolapsed her rectum some time ago. The owner’s only concern was that the daughter, now in London, got to say goodbye as “this is the love of her life”. They assured me she would be quick to arrive, which, in fairness, she was. On arrival she seemed shocked, insisting the horse had been fine a couple of days ago and had lost all the weight since then. As I went to remove the headcollar after euthanasia, a lump of rotting grass dropped out of the mare’s mouth with an even more rotten cheek tooth embedded in it. As I peered into her oral cavity it was clear she had received no dental care for years and it was a miracle she had made it this far. Before I could leave, the mother proudly dashed out of the house with a framed photograph and enormous red rosette, gushing about what a wonderful horse she had been in her heyday… still she seemed oblivious to the fact this only made the situation sadder.

The last case that will always stick with me is slightly different. A very sweet and not so old pony had been dumped at a rural farm after the owner had cleared off in the night with his more valuable horses, due to owing the farmer many months of livery. The well-intentioned farmer had taken the nervous little pony under his wing and the grandchildren had even started to ride as “she is so much better with kids than grown-ups”, so a happy ending should have been had. Sadly, however, when the farmer spotted a large bony mass growing on the pony’s jaw had started to put her off eating, he rightly called our practice for a visit, which confirmed a textbook tumour with a fractured mandible. We discussed the options, and appropriately came to the conclusion that euthanasia was the right thing to do. His only request was that the grandkids got to say goodbye. I came back to carry out the deed that afternoon with new instructions to meet them down a fork in the track to the farm. There in the fading light were the farmer and his son, with a freshly dug hole big enough to bury an elephant, ready to say their goodbyes. They caught me off guard as their matter-of-fact approach gave way to open-hearted weeping as we discussed the issues of burying an injected carcass. They clearly did not want her shot, so despite all their hard work were willing to abandon the burial. As we sensitively discussed the alternatives, I found myself choked up by the situation these people had found themselves in. What should have been a fairy-tale story for this once cast-aside pony and “unhorsey family” had been cruelly taken away by neoplastic bad luck. But what happened next was nothing short of a horrible joke for all involved. The pony suddenly remembered it didn’t like adults (having previously been fine earlier in the day) and refused to let me anywhere near it with a needle. It dragged the farmer’s son through a copse, then the freshly dug pit, on his knees. It would have been funny were it not for what we were trying to achieve. We managed some orally delivered sedation, but this only reduced the distance it could run, not its ability to fight at any hint of being touched beyond its head. We were a long way from the farm and the light was really disappearing now. I suggested that we might have to reconsider euthanasia by bullet if we wanted to get this done quickly for the pony’s sake, with minimal distress, otherwise we needed to get the pony back to the safety of the farm and reattempt intravenous access. Thankfully they saw the predicament we were in and the pony left this world quickly and painlessly in a quiet corner of the farm where there now stands a cross, beautifully decorated by the kids who loved and cherished that pony to the end.

As vets we sometimes have the privilege of gaining access to rare, but all-important, opportunities to influence the quality of life an animal leads. Never are these opportunities more pressing and real than when we are duty-bound to ensure that a humane and timely end is delivered wherever possible

As vets we sometimes have the privilege of gaining access to rare, but all-important, opportunities to influence the quality of life an animal leads. Never are these opportunities more pressing and real than when we are duty-bound to ensure that a humane and timely end is delivered wherever possible. As I always say to my clients, better a peaceful, elected euthanasia than a desperate and stressful emergency one, and something I’m sure many of you say, “better a day early than a day late”.

Lucy Grieve

Lucy Grieve, MA, VetMB, MRCVS, is an ambulatory assistant at Rossdales Veterinary Surgeons, Newmarket, and past president of BEVA (2020 – 2021).


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