Need help/opinions please guys!!!

[missdixie]

Okay with Dixie's latest veterinary fiasco on Friday, I can't help but think I am being taken advantage of by my vet. Please give me your opinion on whether or not you think I am being overcharged, and if so what I should do about it.

Dixie got her leg caught in a cable fencing wire, got it wrapped around her hock, then apparently ran away with it. She had a bunch of sort of gnaw-marks on her leg, and two about 1 inch lacerations on the front ( inside bend ) of her hock. I called the vet for an emergency call because the wound was foaming and her leg was very swollen and she was limping. The vet came out, watched me walk her around, and said that it was a superficial wound ( thank God ) but since it was over a joint we needed to be careful about treating it, and best suture it up at least partially to prevent proud flesh. She sedated her with Ace and Dormosedan, washed and shaved the area, and put about less than 10 stitches into the middle of the lacerations just to help them heal over better with less chance of scarring. She wrapped the leg and gave her her tetanus/4 way booster. She gave me antibiotic powder and extra wraps for her legs. This whole thing took about 2 hours from the time that she arrived. The bill was a whopping $470. She charged $200 for the sutures ALONE, not even including sedation, medication, etc. I thought this was WAY overkill for like 6 stitches. She also charged me $70 for the one booster shot that I pay $25 for at the feed store. The rest was farm call, $45 for antibiotics, extra for wraps, and so on. Let me give you a reference point for why I think this is way too high. My thoroughbred was kicked in the chest a couple years ago and I had to call the ( different ) vet for an emergency call on the weekend to stitch him up. He was sedated, the wound shaved and cleaned, the wound tissue carved, then 20 stitches in two layers- in his muscle then in his skin, with a drain, medication, 14 doses of antibiotic shot, etc. It was a much worse wound than Dixie had and it cost $180. Am I just being cheap here? I know this kind of thing costs money, but it was SO much higher than I anticipated, I feel like I might be getting taken advantage of. I know that this vet is very slow with business right now, because I can tell by the few numbers between my invoices on farm calls, and the fact that she has become really weird about payment. I always pay within a couple weeks if not at the time of the visit, but she actually handed me this outrageous bill and tried to get me to pay right then and there. I really feel like she is overcharging me to help compensate for her slow business. Could this be the case? What do you guys think? If so, how do I go about bringing this up?

[WashingtonBay]

Well, I'm not the type to bring it up... I just know that some vets charge more than others, and you either like the vet and want to pay it, or you use someone else.

I know my preferred vet will be more expensive than the others when I call him, but I think he's better. It just depends.

[JackieB]

I'd say that's quite high. I would be thinking about half that much ($250 or so). If you haven't paid the bill yet, I'd go in or call and ask her to reduce the amount of the invoice. Are there other vets in the area? You could call one or more of them and ask for prices for some of the items such as the booster shot, a farm call, having stitches put in, and so on.

If you like her otherwise, you might be able to say "Look, I don't want to start using a different vet, but I just think your prices are way too high..." If she wants you as a client, she'll adjust the invoice or assure you that her prices are very competitive. Just make sure that you have another vet(s) as an option. There are rural areas around here where vets won't even go because it's just too far out and they get all the business they can handle closer to the office.

Let us know what you decide.

[missdixie]

Unfortunately a much better job was done at the $180 incident :(

[missdixie]

Yeah JackieB I think I might do some calling around to the other vets to see what the normal prices are... I am not attached to this vet at all, she just happens to live down the street so she is convenient.

[Equine_Woman]

Yeah I think that's pretty high but I wouldn't bring it up personally. I'd try and use the other vet if you could in the future if you were happy with them. And some vets are a lot more expensive than others. . .if her clientele is primarily horses and the other vets is all large animals that can make a huge difference in their prices. A cow vet can't charge 470 for some stitches on a cow because a cattle rancher won't pay that. Doesn't fit into their economic plan for their animals. Horse owners don't view our horses as livestock, therefore vets who only see horses tend to be more expensive, because we WILL pay more for our animals. Just throwing that out there as a possible reason!!! Now if it had been the same vet that was so cheap I'd be more upset!! I have a cow vet for shots and a horse vet for everything else, simply because my cow vet is CHEAP.

[alittleoffkey]

I'd think I was being overcharged as well, and I'd find another vet.

For a farm call ($45), to sedate Leggy (and he took a dose and a half - $35), remove a sarcoid from his forehead ($30), stitch it up ($15), a tetanus booster ($15), 10 days of antibiotics ($20) and to have it biopsied ($90), my vet charged $250. That's less than what I was expecting to spend, and I'm pretty cheap.

Granted, you are on the west coast and I'm in a fairly poor, rural area where people can't afford to pay more than the very least for their animals. The vet does have to make a living somehow.

[missdixie]

Well, I haven't paid the bill yet but I think I will call around and try to get some pricing info from other vets to maybe gauge the situation. At the very least I am switching vets for sure, I just feel taken advantage of. I paid her $100 earlier this month when Dixie was limping to come down the street and tell me she had a stone bruise..... I should have made the switch then. This is just the worst timing... I paid $500 on Thursday to get my wisdom teeth out. It's not easy for me to pay a huge random vet bill like this and it pains me even more to think she might be purposely squeezing me for extra money that I don't have just because I'm a horse owner so I should expect to shell out dough like that on a regular basis. :doh:

[missdixie]

Looking at this bill, it seems like most everything is totally legit except for the $220 for sutures and $70 for the vaccine. Maybe I will just play dumb and call her tomorrow and be like "Oh I think my bill is wrong, I was charged $220 for sutures..." and see what she says. I don't care who you are, $40 per stitch is highway robbery.

[JackieB]

If you're definitely switching vets, then you have nothing to lose by at least trying to get her to reduce the bill. The best way to do that for sure is with estimates that you gathered from other vets in the area. "I appreciate that you have helped me when missdixie has hurt herself. However, I found this last invoice seemed rather high to me, so I made some calls to compare. I think $X would be more appropriate, and a very fair amount. Would you please take the remaining $X off my bill? I can bring a check by your office this afternoon..."

It makes for an uncomfortable call, but if you hang up and find that you saved $100 or more and paid a more reasonable fee for the services, it will certainly be worthwhile. If she refuses, then at least you tried.

[JackieB]

Looking at this bill, it seems like most everything is totally legit except for the $220 for sutures and $70 for the vaccine. Maybe I will just play dumb and call her tomorrow and be like "Oh I think my bill is wrong, I was charged $220 for sutures..." and see what she says. I don't care who you are, $40 per stitch is highway robbery.

That makes it even a bit clearer. You can focus on those two items, and especially the sutures.

Anyway, let us know.

[luvs2ride1979]

Wow, yeahm definitely overcharged. I would show her your last vet bill for the similar situation and reminder her that the booster is only $25 at the feed store. Be nice at first, asking her why the bill was so high and if there's a possible mistake, because your other vet bill was so low in comparison.

Let us know how it goes ;).

[rocknK]

Was this an after-hours call or during normal hours?? That might make a difference.

[JennyandJosey]

That sure does seem like a lot. Two years ago my mare had a nasty injury on her butt. I paid $134 for the whole vet visit. Granted, she couldn't stich her up. But she did sedate her and do some surgical type work on her. I paid $20 for the tranq, $25 for the "surgery" and only $8.10 for the tetanus. The antibiotics were $34. The rest was for vet wrap, call charge and exam charge.

[Ryle]

I'm sorry, but I have to say that it may be a bit high, but you also have to look at the fact that that suturing charge included clippping, cleaning, etc. Considering that the full course of treatment took 2 hours and probably quite a few supplies for the cleaning if it took that long then you are adding in the cost for the vet's time on top of supplies the $200 is for more than "just 6 sutures". My biggest concern would be that you had a "foaming wound" and she didn't do something to specifically check for communication between the wound and the joint capsule..... Hopefully she did during the cleanup.

I would also have to say that I would be worried about those vets that charge such small fees staying in business due to both lack of revenue and lack of desire to work that blasted hard for that little pay. Live the lifestyle for a little while and you would understand ;)

[WashingtonBay]

Looking at this bill, it seems like most everything is totally legit except for the $220 for sutures and $70 for the vaccine. Maybe I will just play dumb and call her tomorrow and be like "Oh I think my bill is wrong, I was charged $220 for sutures..." and see what she says. I don't care who you are, $40 per stitch is highway robbery.

Well, if you think about it, the sutures are the part that she went to an expensive school to figure out how to do. They should be the most expensive part. The cleanup and inspection and knowing how, where, when, and how many is what you are paying for, it's not about the cost of the thread.

[vicklynn]

Im thinking she is high, and I didnt mean the price. I have one of the top vets in the area, of course we have a few, but they are all comparable, and prices are more so what you paid on your other leg issue.
None of the vets I would use here, need the money, their business' are booming with very happy customers. So, not all vets that dont charge you your first born, are needy.

[missdixie]

Well Ryle, WB I see what you are saying, but really she just cleaned the wound with dawn soap and soggy papertowels in a waterbucket. Is that normal? She shaved the wound with my friend/BM's husbands hair clippers, and to be perfectly honest, the sutures were some of the sloppiest I've ever seen. I'm really not just saying that, my husband was holding the light for her and he mentioned it to me but I didn't see them before the leg got wrapped. Then when the wrap came off yesterday my BM's and I were pretty surprised to see the random stitch job. I got some ointment from the vet yesterday and she mentioned that she had started to use absorbable, then halfway through she decided to switch to regular, so they are half and half? Honestly I am not just saying this because the bill was high, I have been in the medical field for 7 years and I have seen and participated in putting in my fair share of sutures and this was one random job. My husband said she was too worried about getting kicked to do it correctly, which was true. Dixie was a little fidgety but never kicked out at her, she was under a huge dose of sedation- she was actually snoring when she was getting the sutures. The vet was pretty freaked out about getting kicked the whole time though, she kept telling everyone to get out of kick range when they were 7 feet away....

[rocknK]

So if your husband was holding the light can we assume this was an evening call? That might explain the price.

[grandmadeb]

An emergency call here is $100. An unscheduled during hours call is $60, and a scheduled routine call is $40.

[Palogal]

Wow. I'd say that's pretty high too. What did she stitch her with, silk?
An emergency call is an emergency call there's not much you can do about that I think an EC with my vet is $75 actually but the rest of that is pretty ridiculous.

[WashingtonBay]

Well Ryle, WB I see what you are saying, but really she just cleaned the wound with dawn soap and soggy papertowels in a waterbucket. Is that normal? She shaved the wound with my friend/BM's husbands hair clippers, and to be perfectly honest, the sutures were some of the sloppiest I've ever seen. I'm really not just saying that, my husband was holding the light for her and he mentioned it to me but I didn't see them before the leg got wrapped. Then when the wrap came off yesterday my BM's and I were pretty surprised to see the random stitch job. I got some ointment from the vet yesterday and she mentioned that she had started to use absorbable, then halfway through she decided to switch to regular, so they are half and half? Honestly I am not just saying this because the bill was high, I have been in the medical field for 7 years and I have seen and participated in putting in my fair share of sutures and this was one random job. My husband said she was too worried about getting kicked to do it correctly, which was true. Dixie was a little fidgety but never kicked out at her, she was under a huge dose of sedation- she was actually snoring when she was getting the sutures. The vet was pretty freaked out about getting kicked the whole time though, she kept telling everyone to get out of kick range when they were 7 feet away....

I guess I'd say if that's what you think of her work and her price, then don't use her again, but unfortunately, this job is done, and my style would be to just pay it and be wiser next time. But that's me. I don't like haggling over money.

I don't send food back to the same cook I want preparing my next meal, and I don't haggle over money with vets who I want to hurry out here the next time I want them fast. ;)

[Palogal]

If she gave you an itemized bill, I'd ask, why not?
If someone didn't put a wrong code or something and the bill is correct I would let it go, pay it and not use her again.

[alittleoffkey]

Ditto WB and palo. I'd ask about it, pay, and not use her again.

[missdixie]

I think that's what I'll do. Ask about it, pay, and then switch vets. I won't be rude about it. I am really stressed out now though because I went to the barn this morning and the stitches were put in too tight because her skin pulled so much that it tore an new wound above the stitches/original laceration. So now she has a whole new one inch gaping tear above the original wound from the sutures being too tight. I am so stressed, what do I do??

[Palogal]

Call your vet (the one you like) and ask. I would clean it and wrap it with a sanitary napkin and a polo wrap in the mean time.

[WashingtonBay]

I guess call whatever vet you feel best about calling. Can you take pictures?

[missdixie]

I can take pictures but I put cream on her leg already and so you can't see it, and she'd probably kill herself trying to get away from me if I messed with it too much.... I paged the vet who actually did the stitches but haven't heard back from her yet... I really don't have the money right now to pay someone else to come out and fix her mistakes....:(

[WashingtonBay]

Well, next time you're messing with it, I'd appreciate pictures. I think we can learn a lot what to look for and expect in our own, from seeing these kinds of things.

I understand about not having unlimited funds, between pony colics and car break downs, it's never at a good time.

[missdixie]

Definitely. I will get pictures probably tomorrow, unless the vet comes back out this afternoon to fix it. I will let you guys know what happens!

[Palogal]

I hear ya too.
When it rains it pours.

[missdixie]

Well the vet says she's not worried about it, she thinks it may be that the stitches are intact in the bottom but the top section of skin ripped out of them or something? Weird. Anyway, she ( my horse ) seems to be handling it pretty gracefully, I am just really nervous about proud flesh more than anything. I just ordered this stuff http://www.equaide.com/ and I am optimistic that it will help prevent proud flesh....

[JennyandJosey]

I've used equaide before and it's great stuff. I know of others who swear by it. It should help a lot.

[pandorasmom]

I think it's a little steep also, but that's me. I do know per my vets "expense" paper, his base hourly fee is $180.00. If I'm not mistaken, for an Emergency call he did charge $40.00 last I checked, on top of a 40 dollar Farm call. And for sedation to do Pandora's teeth, I was charged 26.50.

[Joey A]

I know plenty that would charge that much. I know some that have charged more for less. Be ready for them to say the bill is correct, and if you want to challenge it, be ready to pay it and get blacklisted.

I personally would just pay it, find another vet if I was unhappy with the job/cost. I don't like pissing off vets that I might have to call to save one of my horses.

Keep in mind, the new wound may or may not be a mistake. You never really know if that was part of the original injury that didn't show until the first wound was pulled shut. (and pulling the other open) Could be wrong, but not impossible.

[missdixie]

Perhaps it wasn't a mistake, but even if it wasn't, it was still a very shoddy job and a very high fee. I think I am just going to pay it and find a new vet. I am really unimpressed with this one ( obviously ). Thanks for the advice guys!
ETA: I'm not going to argue the bill but I don't think I would get blacklisted even if I did... the vet clinics around here are rather large, this particular vet is a rogue vet that works by herself.

[missdixie]

Okay, I have attached a close up picture of the wound, to give you an idea of the size, the lower laceration is about 1 to 1 1/2 inches long. Don't mind the white stuff, it's medicine, and the wound is not nearly as clean as I like because she won't let me clean or wrap it and it has been draining alot. I hosed it off as well as I could. Tell me if you think these sutures look as weird as I think. After I hosed her leg off and could actually get a good look at the wound, I saw that besides the sutures on the top wound ripping out of the skin, there is a pencil width GAP in the sutured wound in the bottom. I am so mad about this. This is the first time I've actually gotten a good look at it. I called the vet about it and she gave me some excuses saying that the stitches might come out by now ( I told her they didn't come out ), and do I remember her telling me that there were no guarantees on the stitches in the first place ( no? ) and that the stitches would still help prevent proud flesh.... and so on and so on. I said, how can the stitches possibly prevent proud flesh if the wound is not even closed? What is the point of this whole thing if the wound isn't even closed? She said that the stitches were fine before but now they're just coming out, but I kind of think that's bull. The sutures are still intact, but they are super loose. I don't know if they were loose like this in the first place, it was too hard to see clearly because of the swelling and the scabbing and draining. To me this leaves two options: 1. She was so nervous and going so fast that she put the sutures in gapped like this in the first place or 2. She didn't tie the sutures as tight as she should have in the first place so they came loose. I really feel that if the sutures had been put in correctly this wouldn't be happening. I am so mad because the whole point of stitching was to prevent proud flesh, and now that is totally out the window. For all the good these sutures did I could have just bought the antibiotics and tetanus booster and treated it myself and saved $400. Please have a look and give me your opinions, maybe I am just to emotional to see it objectively right now.

[WashingtonBay]

Well, it could be that there just isn't enough skin there to pull them closed without them tearing. Especially near the joint that will bend and flex. Cuts aren't always clean and straight and tidy. They're jagged and rough. I think the wounds themselves look pretty good for a few days in, if they were going to swell badly or get infected, you'd be seeing that by now.

Thanks for posting the pic!

[missdixie]

The thing is she insisted that they WERE closed when she did them.... that was the only reason for getting the stitches. She told me we could either do it or not, but that if we closed the wound the chance of proud flesh would be almost zero.

[WashingtonBay]

Have they stretched wider or did you not see them at the time? Has the leg swelled since?

[missdixie]

BTW I really really appreciate you guys giving your input on this. It's hard for me to see things objectively with Dixie sometimes, so it's good to get some other eyes and ears on the situation :)

[missdixie]

I did not see them at the time, hubby thinks the wound was closed at the time from what he could see, but he wasn't very close. I honestly have not gotten a good look until now. The leg has not re-swollen since then.

[missdixie]

BTW is it really possible for them to stretch wider if they were tied tight enough in the first place? It seems like they couldn't loosen up like that unless they weren't tied tightly.

[WashingtonBay]

Well, I know you'll never be happy with that vet, but hopefully you can have some input that at least you don't need to worry about Dixie. I don't know really, I don't have a whole lot of medical experience myself. My horse wounds have been few and far between, that's why I like to see pictures and reports from you guys so I know what to expect!

[HaveFaith]

Sounds high to me. Last summer when Faith cut her knee it was $160 for suturing a 3 inch laceration over a joint, ABX. shot, tetnus, and by mouth for a week, Bute, Probiotics, and he had to put her to sleep and lay her down. Wrapped, but no extra bandages. The main difference was that we took her to him.

[WashingtonBay]

BTW is it really possible for them to stretch wider if they were tied tight enough in the first place? It seems like they couldn't loosen up like that unless they weren't tied tightly.

I think they can definitely pull apart from swelling or movement. I had stitches in my own back from a large mole I had removed, and the doctor told me to be careful pulling and moving too much or it would scar, and I ignored that advice and pulled them and it did leave a scar. It's hard not to have that happen with a horse, and a wound that is right on a joint.

[missdixie]

Thanks WB. I am picky but I do like to think that I always try to give people the benefit of the doubt. The thing is, I have been in the medical field for a long time, and have seen and helped put in and take out alot of sutures and I have never seen anything like this before. I won't be using the vet again, I am just so frustrated with the situation, I feel like it was not treated correctly. I'm wondering if I should ask her to discount my bill because they stitches did absolute jack diddly to help the situation. I just feel like it was a huge waste of time and money. She did mention how she could come out and cut off and treat the proud flesh if it grew.... another huge charge- how convenient. I am not super worried about the proud flesh at this point because I ordered the Equaide, I just feel like this was a really expensive substandard job. I'd love to hear if Ryle has ever seen anything like this before.

ETA: Really WB? Did he say they would stretch or just that they would tear the skin or rip out? I have heard of stitches ripping out, but never loosening?

[WashingtonBay]

On your question, I'm really not sure which thing happened in my case.

[alittleoffkey]

I think the stitches would have pulled out. I don't think they're stretch-able. That's a pretty ugly wound, I don't think I would have considered it stitch-able in the first place - granted, I'm not a vet, but I have managed stitches myself a couple of times.

Draining always makes me nervous, if it starts to swell again I'd have another vet out, asap. I could be completely off base; I'm interested in what AUEquine or Ryle has to say as well.

[missdixie]

Okay maybe this really is my fault for taking her advice and getting the sutures done in the first place, and I should just take it as a lesson learned. I just cost myself alot of money for thinking with my heart and not taking the time to weigh the advantages of having the sutures put in. Something tells me no matter how upset I get, there will not be a resolution to the situation and I just need to suck it up, treat it myself, and switch vets. I am just really kicking myself right now for racking up that bill trusting that the sutures were the right thing to do. I am really interested in getting all your opinions though. Thank you WB and ALOK, I can always count on my forum buddies for good advice!

[WashingtonBay]

I don't think having the sutures themselves was a mistake, it certainly isn't hurting. The wounds might well be bigger with more loss of tissue if you hadn't.

[missdixie]

LOL, the only thing it's hurting is my checking account!

[WashingtonBay]

Oh - yes.... besides that ;)

[AUEquine]

Do you really care about a scar/proud flesh? Is she a show horse?

I just showed that pic to one of the vets that I work with, and he just started laughing. Said he wasn't sure what those suture on the top wound were supposed to be doing. His recomendations were to just take them out and let the wound heal as it is.
However, we have never seen this horse physically nor the wound, so this is not 'valid medical advice.' Just an observation.

As far as the bill, it's a little on the high side. Our standard laceration bill here is probably just under that, including emergency fee ($200). For a good thorough job that bill is not bad, I think the division of the charges are a little odd, but the over all total isn't too far off. However, note that I said that was for a thorough job. Like Ryle said, any would that close to a joint should have been checked/flushed to make sure the joint wasn't involved. This is just standard on any would on a leg.
I do recomend finding another vet. There are just alot of things I question about this vets actions. What I mentioned above about the joint issue. Also, I don't know how much I trust a vet that doesn't even have a pair of clippers on the truck. And I also question the use of Ace. Detomidine is a very common sedative for a procedure like this, Ace is not. We rarely use Ace as sedation, only as a vasodialator.

Glad it wasn't worse, and hope she heals up soon!

[WashingtonBay]

Do you really care about a scar/proud flesh? Is she a show horse?

I just showed that pic to one of the vets that I work with, and he just started laughing.

Oh dear... she ain't gonna like that. :huh:

[missdixie]

Thank you for your thorough reply AUEquine!!! I was thinking the same thing about the top sutures, her skin ripped out of them anyway. It was weird because the vet started with absorbable sutures then switched to regular? I also thought that was nuts when I saw on the bill that she used Ace, she is lucky she wasn't under Dixie when she suddenly judo kicked into the air out of nowhere 5 minutes after it was done. I am just so disappointed with this whole situation. She is not really a show horse, mostly pleasure. I just didn't want some big lump of proud flesh affecting her leg bend or anything. Plus she is my baby so I didn't want any disfiguring weirdness on her. Thank you for your opinion, I so appreciate it.

[missdixie]

LOL WB, I am already past me breaking point with this one, I am not really sure what to do at this point.

[JackieB]

Sorry, missdixie. I'm sure this must be agonizing for you.

[JennyandJosey]

Do you really care about a scar/proud flesh? Is she a show horse?



A scar is one thing...but I was always under the impression proud flesh was not ok to just leave on a wound? If there's a lot of proud flesh then the wound is not healing. I would think you would want to get rid of that whether a show horse or not?

[AUEquine]

A scar is one thing...but I was always under the impression proud flesh was not ok to just leave on a wound? If there's a lot of proud flesh then the wound is not healing. I would think you would want to get rid of that whether a show horse or not?

Proud flesh is scarring. Scarring can include hair loss, hair color change, proud flesh, etc. Proud flesh occurs when the skin cells reproduce rapidly when healing a wound and have trouble stopping. Proud flesh itself is not dangerous to the horse. The only time it's a true problem if it forms in an area that inhibits movement.

Other times that proud flesh causes problems are when it inhibits a horses natural processes. For example if a horse chokes and the esophagus is damaged too much, the healing process can produce a scar (it's not really flesh inside the esophogus) ring around the esophogus that is not flexible and basically will cause the horse to rechoke.

But unless the proud flesh is causing some sort of problem, the only issue with it is strictly cosmetic.

[luckydoublesranch]

I am so sorry you are having such issues with this injury and the Vet service you received. :(

I just thought I'd throw out my opinion and what I've run into with Vets I've worked with and hope it helps somehow.

Proud flesh is the over production of tissue (exuberant granulation tissue) usually triggered by an injury with an open wound. The lower (distal) region of the legs are the most prone due to the fact that the tension on the tissues is greater, there is very little muscle or fatty tissues there, and the leg is an area of constant movement, thus creating more irritation and disruption of the wound. The most routine method for controlling proud flesh on lower limbs is to first close the fresh wound as soon as possible usually with sutures. Secondly, a counter-pressure wrap should be applied to bring the wounds edges together, to continue constant pressure on the wound, and to protect and eliminate some movement. This in turn lessons additional irritants that can contribute to the granulation. Antibiotics and anti-inflammatories are also very commonly used to prevent infection and reduce swelling. (It looks to me like swelling may have been a factor in the loosening of the stitches) Swelling also constricts blood supply which equals lessened healing abilities and can result in the animal being "bothered" more by the wound and disrupting it which starts a vicious circle. Proud flesh IMO is not only cosmetically a problem, but can GREATLY slow down the healing process, become a challenge to get under control and should not be taken lightly. A normal wound will heal by the edges the of skin closing over tissue granulation. When proud flesh becomes "out of control" the tissue edges cannot close and the granulation begins to errupt over the wounds surface. This is where the big problems begin. The granulation continues layer over layer and can become huge if left untreated and usually will not heal on its own, leaves an open port for infection and becomes a BIG problem. Here's a few pics that I just grabbed of a Google search for reference.
Please keep in mind these are extreme examples...not what we are seeing with your horse, but I thought for learning sake we should see some worst case scenarios. :)
http://www.ecmagazine.net/Summer07/Summer07Photos/wwProud%20flesh%201.JPG

http://www.equinefirstaid.co.uk/casestudies/crackers/crackers_first_small.jpg(this pic is closer to a "common" case of proud flesh)

http://i42.photobucket.com/albums/e345/baroquenz/afterbioptron3030507a.jpg

The treatment options for the over-granulation at this point are usually removal and debridement of the tissue in conjunction with a counter-pressure bandage and steroid cream. Steroid creams are used to slow down the growth of granulated tissue. This is all in an attempt to allow the tissue edges to come together and heal. The other treatment is to use a caustic substance to "eat" away the granulated tissue. The surgical route IMO is the better one as using a caustic substance also damages healthy tissue along with the over granulated tissue.

So after scaring the crud out of you, take a deep breath......at this point there is no proud flesh evident and remember that development is determined by a lot of variables. The size, depth, involvement of the wound, how quickly proper care was given, rest and immobilization, and on and on. If you could possibly desensitize your horse to having a bandage applied properly I would think that would be a great help in the matter. Also keeping him quiet to limit movement and disruption of the wound is helpful. But above all else, if you have questions or concerns, consult another vet. :)

[Ryle]

It looks like she did what she could to close a large wound and make the gaps as small as possible while still trying not to put too much tension on the sutures. Leaving a gap in the lower laceration was an attempt to narrow the area that the body had to fill in to get it healed but because of the location and the amount of tissue lost she couldn't pull it all the way closed because the sutures definitely wouldn't have held then. I don't see anything that would make me think her suturing job is shoddy.

Since she won't let you clean and wrap it easily, you may need to talk to your vet about getting a bit of ace you can give her to sedate her enough for you to be able to deal with it. Or get a humane twitch and twitch her.

But it doesn't look bad overall. In fact if you can keep it that clean and really keep her stalled up to prevent movement she should do just fine.

[Joey A]

I just saw your picture, keep in mind that the skin there is also really thin. With the big wounds like that I've seen, when the skin starts healing it actually pulls away from the injury and "dies off" (technical term, lol) before the body starts to rebuild tissue. Kind of a "retreat and re-group".

I'm surprised that the vet tried to suture, but from what I've seen on these types of wounds it wouldn't surprise me at all if that wound really was shut at one point.

[grandmadeb]

I just received my bill for an emergency call at the clinic for colic. The clinic call was $100. The colic treatment was $150 including an exam tranquilizer, rectal, check reflux, tubing with oil and electrolytes. She also charged $50 to treat the cuts on his back legs including cleaning and clipping. A roll of cotton was $6 and Naquasone Paste was $40. A grand total of $346. Good thing they will let me pay it in two installments!

[Tiz]

The blue soap was Nolvasan, which is a surgical scrub. Ace for sutures? No wonder she was nervous, unless she numbed the wound directly. Maybe you didn't see that?

You'll be surprised at how good this will look when it's healed. Try not to fret too much over it.

[grandmadeb]

Al had a sarcoid high up in back of his right front leg. It was cryo frozen and a couple of days after we got him home it fell out leaving a huge gaping hole. It was bigger than they thought. Anyway, we used Schribner's herbal spray on it and it healed beautifully. We have also used a product called Derma-Clens from Pfizer. You might ask your vet if either of these would help prevent proud flesh. I know they have both worked for Al.

[Horseaholic]

The sutures in the top wound are doing absolutely nothing. I'm surprised that she suggested sutures for this...I understand her good intentions but I think that this wound is not a preferable case for sutures. The top suture in the lower wound looks nice (the top left). As for the others I'm going to keep my mouth shut because I am NOT a vet. If she was not comfortable suturing she shouldn't have been... I'm not one to hen pick at money but I would definitely express my dissatisfaction in a tastily manner. Is she planning on charging you to remove the sutures?

[AUEquine]

I just received my bill for an emergency call at the clinic for colic. The clinic call was $100. The colic treatment was $150 including an exam tranquilizer, rectal, check reflux, tubing with oil and electrolytes. She also charged $50 to treat the cuts on his back legs including cleaning and clipping. A roll of cotton was $6 and Naquasone Paste was $40. A grand total of $346. Good thing they will let me pay it in two installments!

Wow, that's actually a very good price for an emergency colic. Our emergency fee is $190, our colic work up is $200, and all drugs are extra.

[grandmadeb]

I'm not complaining because they bend over backwards to get him in when I call. His colic history is not too good and like me, they want to treat it early when it happens. This one was mild but I can't delay as colic can go from bad to worse in the blink of an eye and I don't like to wait to see if it will pass and then end up in a bad place it it gets worse. I don't have another stash of money for surgery and after one another is not in the cards. .

[WashingtonBay]

We got off easy on the last pony colic. I think it was $270. I've paid as much as $400 before. There was a charge for night-time farm call, he tubed and oiled her, remarkably not needing any sedative for that. He could tell she wouldn't stand for a rectal exam without sedation though, and he didn't even try. It probably would have been more if he had ;) I guess if they aren't sick enough to stand for it, they probably don't need it.

I had already given her Banamine, so there was no charge for that.

And he sold me a thermometer.

He drew blood for use in possible testing later, but didn't charge for it because we didn't end up needing it.

[josephathony]

Sorry the vet took you on charges .Butnothing you can due but pay and don,t use again .Tell peopleon over charge you got .Also let vet know how unhappy you are with charges maybe will adjust for uu If just say word spreads fast among horse people on unfair cost so beware of that vetds prices . JOSEPHATHONY GOOD LUCK:cowboy:

[missdixie]

Hey just wanted to update you guys- thanks for all the advice, I went ahead and sent a letter to the vet very politely asking if she could lower the bill without mentioning what I thought of her work. I simply said that the bill was much higher than I anticipated, and also much higher than on worse wounds I've had treated and stitched before. That was almost a week ago and I haven't heard anything, but I haven't paid the bill yet either, won't be able to for a week or so. Tiz- the soap was not Nolvasolan or whatever it's called :) It was definitely Dawn dish soap- she poured it right out of the bottle into a bucket, dunked some papertowels in and washed her down with that. She did Ace her, and she did some local Lidocaine too, but she was still really afraid of Dixie. It was kind of weird. As for how the wound is looking, the top cut has a nice flat scab over it now, and the bottom laceration is really covered in big chunks of blood/serum scabs which has also covered the front of her cannon bone, but it is looking better. I plan on cleaning it and using Equaide tonight with the help of a team of friends :) As far as the sutures, depending on how she acts tonight I will take them out myself now. If she is too hot to handle I will take them out later. I am not paying for a farm call for it though- I've taken sutures and staples out of people and horses so I'm not paying the vet $100 to do it for me when she's afraid of my horse anyway. I will try to get some good shots of it tonight for you guys to see how it's doing.

[Tiz]

A regular dish soap bottle, with a Dawn label? Did it turn the water blue?

[missdixie]

Yes a regular Dawn bottle with the Dawn label, and no it didn't turn the water blue......

[Tiz]

Huh

[AUEquine]

We use Ivory dish soap quite comonly for cleaning of horses.

We usually don't use nolvasan around open wounds or on faces, for those we usually use betadine scrub.

Don't know what type of dawn that was used, but most dish soaps are great antibacterial soaps, just avoid the ones with lots of dyes and scents. I know when I had my belly pierced they told me to wash it with dial anti bacterial soap.

[Miracle Whip]

I don't think ANY emergency call to a horse vet is going to be less than $200 but $470 seems a bit high. Was the animal hard to handle? Did you have a place where she could work on the animal indoors that was clean?

Not that any of that affects the prices that she charges but it does help I think if you have a place for them to work on the horse. I never did so I trailer mine down to the clinic.

Could you itemize (list) the charges so I don't have to re-read the entire post? That would be helpful.

I would say its because the vet didn't jive with Dixie. My mare does not like the vet north of here. He came out once to try to sedate her and couldn't. Said to call his office and we'd try another day. Then he said, I could not afford what he would charge me to work on my horse and I should find another vet. He advertised himself as a horse chiropractor and a horse dentist...he was here for her teeth but I had to board her overnight at a stable to have her teeth done. And the vet who did her then hated her guts. So I will probably never have her teeth done again...we shall see.

[Miracle Whip]

In regards to proud flesh

My mare really ripped open her hind knee joint. IS that the hock?
Anyway, for better or worse my Dad didn't think we could do anything for her. I think he had the cow vet out, I don't remember. We did nothing for the wound that I recall. No cleansing, MAYBE some antibiotic shots...(penicillin) it took over a year for that leg to heal to the point where there was hair on it. There was always proud flesh and as time went by the joint got somewhat smaller. It had crusty scabs on it most of the time.

Now please don't attack my dad, this was 20 years ago. I only mentioned this because the horse WAS sound during and after the healing process. It looked like heck but she was never truely lame either. Most people nowadays don't want a horse with a funny looking leg.

We sold Paint for $500 as a trail horse in the late 1980's. I thought that was a good price at the time but a little silly because she kicked. Just goes to prove what people will spend on a Paint.

[missdixie]

Okay, update:
I went and cleaned out her wound ( with the help of two men ;)) on Tuesday. I was able ( with much resistance ) to get it very clean with a sponge and warm water. Sorry I didn't get pics, I was trying not to die at the time. So the bottom stitches of course were just hanging there. I clipped a couple off but that's all I could get because she was freaked. I didn't realize how bad the wound was until I got a good look at it clean. The top cut was healed, but the bottom cut was deep, and the stitches literally did not do jack squat. It looked like it would have been better if it were never sutured in the first place. The wound bed looked healthy and there was no infection and no swelling or heat but it was like 3/8 inch deep, sort of like a hole. It looked painful. I painted some Equaide on it, then put a nonstick telfa pad, wrapped it in thin gauze, then in poofy gauze, then in vetwrap. I was trying to make the wrap large so that she couldn't bend her leg so much, because I could visibly see the wound opening everytime she lifted the leg. I then wrapped a polo wrap on her cannon bone below it so that it wouldn't slip. To my great surprise, it was still all 100% intact when I went out last night. I will try to take it all off and do it again tomorrow and I will get some pics for you guys. It looks ugly, but the tissue is healthy and pink, and she has not been lame whatsoever so it is probably a similar situation to yours Miracle Whip. I just have to figure out how to speed up the healing......

[outriding01]

Dang, sorry about all your trouble! I read the whole thread but wasn't able to find if you said what time of day/night this was? It's been years since I had an afterhours emergency, but I remember them costing more each than a brand-new Channel purse (one was in the $500-600 range). One colic around 11pm and one eye lid ripped open around 9:30pm. And we hauled in to the vet's office for both of these. But an amazing job was done with both. Colic horse literally reared and struck out at the vet 3 times and even though he was a full size QH, would not allow himself to be tubed with anything bigger than the small pony tube.

[KCandAllegro'sMom]

That seems a bit high to me as well - especially if it wasn't an after hours/emergency call.

I paid $462.50 that for an emergency call on Allegro last summer. The the trip call which was originally $55 but another person caught him after me so he cut it in half (27.50) which was nice, $65 for an emergency call, and $40 for an exam (you would think that would be included in the trip call - I mean I'm not going to call you out and not have you look at my horse)

....but I had lab work ($85) done and he gave me options that could have saved me money. It was $102 for 2 Zylexis injections, $21 for a Banamine injection, $15 for a vitamin injection, $35 to tube him, $32 for Banamine paste and $40 for sucralfase tablets

This was the first time I had used this vet and I was very pleased with him (my other vet had just closed his practice so I was vetless at the time). Turns out Allegro had a some type of virus and was fine a few days later. But it was pretty rough. He had diarrhea, had temps rangingin in the upper 104s and wouldn't eat/was barely drinking.

Add to it that it was extremely hot out since it was summer and that just made it worse. I spent hours just hosing him down trying to bring his temp down and letting him graze.

[Ryle]

While dish soaps are often antibacterial, they are not designed for use on wounds and are harsh and damaging to sensitive tissues. They are NOT a reasonable choice for cleaning wounds and can slow healing and lead to proud flesh. That would be one reason that I would be upset with this vet.....betadine or chlorhexidine (nolvasan) are appropriate choices for wound cleaning and should be well-diluted.

Are you still keeping her stalled? If not, you really need to or you are going to have slower healing and much more ugly healing. Minimizing movement of these joint areas is extremely important during wound healing.

[Syble413]

Do you really care about a scar/proud flesh? Is she a show horse?

I just showed that pic to one of the vets that I work with, and he just started laughing. Said he wasn't sure what those suture on the top wound were supposed to be doing. His recomendations were to just take them out and let the wound heal as it is.
However, we have never seen this horse physically nor the wound, so this is not 'valid medical advice.' Just an observation.

As far as the bill, it's a little on the high side. Our standard laceration bill here is probably just under that, including emergency fee ($200). For a good thorough job that bill is not bad, I think the division of the charges are a little odd, but the over all total isn't too far off. However, note that I said that was for a thorough job. Like Ryle said, any would that close to a joint should have been checked/flushed to make sure the joint wasn't involved. This is just standard on any would on a leg.
I do recomend finding another vet. There are just alot of things I question about this vets actions. What I mentioned above about the joint issue. Also, I don't know how much I trust a vet that doesn't even have a pair of clippers on the truck. And I also question the use of Ace. Detomidine is a very common sedative for a procedure like this, Ace is not. We rarely use Ace as sedation, only as a vasodialator.

Glad it wasn't worse, and hope she heals up soon!

I know this off topic but I'm just sitting here wondering if putting stitches that close to a joint is something that most vets would recommend. When Lacey was at UGA, I remember a vet saying that stitching a leg wound at a joint is not a good idea because of the risk of tearing when they move.

[Ryle]

Whether to stitch, how to stitch, etc is always a judgement called based upon exactly what you are looking at at the moment. There really aren't a ton of hard and fast rules.