Bloomin PSD - back to square one!!!

alsxx

alsxx

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Previous post on girlie: http://www.horseandhound.co.uk/forums/showflat.php/Cat/0/Number/3525543/an/0/page/4#3525543

Following last post, i had a long conversation with vet who basically said because she was sound when she went in for investigation, they couldnt do the nerve block, and without a successful result from that they couldnt resort to surgery. Also said that once the 3 months were up I am to do everything I want to with her, basically not p*ss around trying not to break her, if anything i need her to go lame in a shortish space of time so I am still covered by the insurance.

Well we are 3 and a bit weeks in on the wait and see approach, the ridden exercise is now up to 25 mins a day and there is only one cartrophen jab left to be done. And now she has gone lame
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She has been a very good patient on the box rest - until she comes out of the stable and then she EXPLODES
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bronking on the bloody concrete, hooves flying everywhere and me wincing at every clatter of hoof!! She is fine to hack, its just getting on!! Anyway this morning I lunged her for a couple of minutes in the school to see how she was looking - still not 100% sound in my view (but i think the vet would have passed it tbh) but a lot lot better than before. Anyway grazed her in hand afterwards and the witch had one of her moments, couldnt hang on to her for the life of me and off she took, round the field at break neck speed, bucking and leaping and just generally galloping as fast as she could
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- yes she looked like she had a bloody good time of it, at this point i could have cried.

Anyway, we went for our exercise tonight and she wasn't right, felt short behind. So lunged (and got an audience as i am paranoid I'm being paranoid with her lameness sometimes!!) and yes she is now more lame than she was in the first place
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lucky in a way i had something to compare to by looking at her this morning.

So looks like I will be calling the vets AGAIN tomorrow so god knows what they will say. I guess I'm hoping that this means they can now do a nerve block - but I'm stuck if they want her to go in as I have no lift for a couple of weeks, and by then she will probably be sound again
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oh what a nightmare!!

Also PSD experts, i posted earlier about the vet report mentioning pelvic assymetry - could this have caused the PSD in the first place???
 
Don't know about the hip thing, but I would change my vet;
They could have scanned her to see whether the ligament had thickened. It is very hard with hind legs as there is no heat or swelling, and sometimes very little lameness.

I think the operation would be a good bet tbh.
Mine went loopy like yours, and had to have a stable sized paddock complete with very high energized electric fencing!
Good luck.
Mrs Mozart, PSD is Proximal Suspensory Desmitis? or something like that, thickening of the suspensory ligament high up!
 
Jmd - they did scan her and there was a 'slight thickening' as vet described to me. I questioned long and hard about why we were doing the wait and see approach and he said it was because she was sound they couldn't nerve block, and without a successful nerve block they couldn't operate. But he did say that yes she was an ideal candidate for the surgery. I guess I will see what they say shortly when I ring up - and dependant on that I may well get a second opinion!

She was very depressed this morning which isn't like her at all; I feel so terrible for her.

Yep mrs mozart PSD is proximal suspensory desmitis - otherwise known as an absolute nightmare!!
 
Also...should I tell them she bombed round the field or just make out its from the exercise...?? I don't want them to turn round and say that its to be expected given what she did and to carry on as we were??
 
I would be inclined to find a vet that will do some shockwave on her. I have read many articles that suggest that the injections don't work and neither does box rest alone. At least if you are having the shockwave there is something to be working on. Alee has her last one on thursday then she will be reassessed in 2 weeks to see if she is sound. I haven't even had her out of walk since the box rest started as I don't want to feel dissapointed again if she's not sound....... Try asking your vet for some ACP to take the edge of your horse it may help. As for the pelvic assymmatry I'm not sure if it could cause a problem but I have read somewhere that mediolateral foot imblanace can play a part. Surely if the pelvis is wonky it will carry on being wonky down the leg and into the foot???!!!!!......just a thought
 
Thank you for the explanations of PSD. And yes, sounds horrible! I don't know what my mare has, other than her hind suspensory ligaments are chronically damaged (at just four years old in light work!), but we went through something similar to you I think. Tig's pelvis goes asymetrical and she loses the muscle on the top of the off-quarter. McTimmony back lady has managed to put it back twice: then we did lots of short punchy work to build the muscle, but three weeks off work and the muscle has gone again. Back lady said it should not keep going out and muscle should not disappear like that. Our vet recommended a bigger practice so off we went, but it was one of Tig's non-lame days... X-ray on hock and stifle, which were clear, and told to go away and bring her back when she was lame - no reference at all to the muscle loss or asymetry (despite asking). Was told to go away and make her lame and make a video of her. Awaited their report and follow up recommendations, but still waiting over two months later (although I've had the bill and a reminder). Three weeks ago lameness came back with avengence, took her to Newmarket on our vet's recommendation. Knew as soon as we got there that they would find out what was wrong! Bone scanned, which showed nothing; then nerve blocks, which led to the diagnosis. What I'm trying to say is, I wish I'd gone to Newmarket sooner. I wish I'd known better and been more pushy. It probably wouldn't have made any difference in the end, but I can't help thinking that just maybe... Sorry, not being as eloquent as usual! Hope you get sorted soon and that yours is not the same as ours.
 
well being an osteopath and having spent the morning with an extrememly experienced one- i'm just beginning my osteo on equines, i have to say i share her point of view that just manipualting isn;t enough, there has to be a combined approach with farrier vet and whoever does the body work, if she is not straight through the foot/limb then she will never come right. so have a look at her and see if you think her hoof and leg are straight and working straight if not then perhaps some change in the farriery approach is needed for that particular hoof and then work will need to be done to straighten etc etc the rest of her. it is quite likely that her anatomy led to the psd as the forces through the limb would have been disrupted, pm me if you need any more info etc.
 
Vet coming this evening so am going to be asking about it all (again!!). I had initially thought it was due to foot inbalance (the PSD that is) as we were stuck with a crappy farrier that we HAD to use at the yard I was on; when I moved yards, new farrier said feet were really unbalanced, particulary behinds and went hell for leather straightening her out. Vets said likely that was what had done it. We are now on third farrier as i strongly feel 2nd farrier did too much, too soon which led to this. But i need to ask the vet how to go about straightening her out, i need someone to come out and look at the back now, but do we do the back first, or feet first, or altogether????

Mrs Mozart - my girl is only 5, and she has done very little really, I've taken everything really slowly and carefully with her which makes this all the more frustrating. And i know exactly what you mean about wishing I'd done things differently and being more pushy. I'm going to really try and push for an answer this afternoon, but i'm so soft so if i dont manage it will get a 2nd opinion.
 
Hope it went well this afternoon. My girl is four, I've had her for a year and she was backed two months before I got her. I was paranoid and have taken things so slowly at times I'v been accused of going backwards. It's all a big pile of yuck. Fingers crossed that your farrier and vet can bring it all together. Hugs.
 
Well I can honestly say that I just feel like crying after last nights vet visit.

He came out, basically said she has a different kind of lameness to before; before she was 'short' and now she's not but she sort of drops her hip every stride. Tbh I thought she looked about the same as last time, just worse-she was doing the hip thing before as far as I can tell. She also wasn't as lame as she had been on sunday which is annoying.

Anyway she was a witch, lazy one minute and crazed wild beast the next - managed to kick my thigh whilst I was lunging her, fortunately it didn't hurt! Anyway he said to carry on as before!!

At this point I was like but its obviously not working; its not practical for me to be doing this and I don't want to spend 3 months farting about if she's just going to go lame as soon as she can do 'normal' work or goes out in the field. Apart from the fact I'm wasting time and insurance money. I said last time you said that you couldn't do a nerve block as she wasn't lame, now she's lame so can't we do one? So under duress he did, he put a needle in and said that he would block the bit that would be cut with the surgery. Gave her 5 mins then lunged, he said there was an improvement but she still put in the odd stride not right. Tacked up and trotted her round the school, did some 15 metre circles - she felt better and he said she looked better now than on the lunge. Tack off and lunged again - he said there was a definate improvement to when we lunged straight after block, but did say every now and again she 'hitched' with the hip. So if the block wasn't quite 100% succesful then what else is going on with her - surely that should be looked into??

Basically he said that still carry on as before, and if that doesn't work he will block again and they can operate. Said he didn't want to cut her open straight away, but give it a couple of months to heal.

I asked about the pelvis, fine to get someone out but he doesn't think its linked, either by cause or effect to the PSD. I gave up at this point, and just thought I'd get a second opinion. I just want to get her fixed - he said himself the chances are slim she will come right, however surgery offers 80% chance of success. I can see where he is coming from wanting to wait, but why put her through 2 and a half months extra box rest when they could do it now? If surgery doesn't work then fine, ill draw a line under it and we did everything we could.

Cookies for getting this far!!! Xx
 
goodness what a nightmare for you, i think that perhaps a second opinion might be good even for your piece of mind at least. hmm interesting he doesn;t think a pelvic problem could be involved with psd, perhaps a little shortsighted since if the horse is not working correctly then the line of strain placed on the leg changes and thus can predispose that area to injury, but hey what do i know i'm just an osteopath that spent 4 years at vet school!!!
get a good osteop/physio or whatever and work with them with the farrier and the vet to get her right i'm sure there are lots that can be done to hep her mechanically and even if she has surgery it will all help the rehab anyway.
 
Go to Newmarket or Oakham I reckon. My boy had his LH done by Sue Dyson and his RH at Oakham a year later. Both ops been very succesful and he's back eventing again and going well.

I actually do believe PSD is a secondary thing and in my case I think it was due to an old SI injury which caused him to compensate/strain the suspensories.

Remedial shoeing helped the RH - we went through a phase of treating it with shockwave and remedial shoeing - but then gave in and operated after all.
 
Oh and forgot to say- Sue was able to block and diagnose LH lameness that neither me nor my local vets couldn't even see. I knew he was wrong but not sure where. Local vets thought it was LF...
 
See neither newmarket or oakham are anywhere near me - I'm down in kent and I don't have my own transport, so to get her to either will not be easy or cheap.

I'm speaking to a second vet today so will see what she says I guess. I rode the poor thing last night to see if there was any difference once the nerve block had worn off (vets idea) and she was even more lame than ever before - I guess where we had been working her hard the night before. Need to let him know this morning, but he advised on monday that even if there was a big difference he still wants to continue as before. Its hearbreaking knowing we can potentially put an end to all this but we're not!
 
Forgot to add, I'm between a rock and a hard place - insurance co said by all means get a second opinion but they won't pay for any diagnostic tests that have already been done if the conculsion remains the same. Which is frustrating as I'm not questioning the diagnosis, I'm questioning the treatment.
 
Why don't you try getting a referrel to the RVC thats where my girl had her PSD diagnosed. She was seen by Ehud who in is a great vet with a hell of a lot of experience. Its probably not too far from you either.
 
Insurance should cover all transport costs if you use a transporter. I found several times that referral resulted in a different and 'correct' diagnosis so I got to open yet another claim.

The cost of a few repeat nerve blocks may actually by worth it to get to the right treatment and a speedy resolution..?
 
I've been looking into Oakham and AHT - looks like I would need vets permission to get her to them, or go back through the whole process again directly with them, obviously cant do that with AHT. To be fair, she has only so far had a nerve block and an ultrasound - so i wouldnt mind paying for that again as wouldn't be too costly in the grand scheme of things.

I think when they first told me yesterday they wouldnt pay I just felt depair, but having ridden her last night on vets orders and she was so so sore I will now do/pay anything to fix her.

I'm still waiting for BOTH vets (present and one i'm going to get 2nd opinion from) to call me today...so no further forward at the moment.
 
Well we are getting second opinion done on saturday morning...so keeping everything crossed.

I'm going to make sure she is lame for then (feel very bad mummy for even contemplating that) so we can hopefully get to the bottom of it once and for all.
 
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