Changing Behind - Update

[HayleyUK]

Following on from my previous thread :http://www.horseandhound.co.uk/forums/showthread.php?653136-Youngster-Changing-behind-in-canter

I pushed on with working her on the lunge in a variety of different set ups (with saddle, without saddle, roller, no roller etc) and found that with the work, she developed a much more 'normal' canter on the left rein with fewer changes each time - but in the main it remained balanced and quite nice to look at for much longer periods of time. She still displayed the changes behind on the right rein - i'd even be inclined to say frequency increased. I also noted that the stride length behind was very close, there really was little difference on the right, but it was textbook on the left.

The tack made no difference whatsoever - which was a good starter point.

Watching her - it was clear she was holding herself very differently on the right compared to the left, and the more i worked her and watched (massive benefit of lunging her!) the more obvious it became that she was unhappy - facial expressions. movement and the way she just carried herself.

The vet came last night- and we redid the radiographs of the back - and it appears that there is still some impingement. We've asked for the initial ones from Leahurst to compare. However - on palpitation there is zero reaction, literally nothing - she's soft over her back, comfortable and the physio/vet both feel that isn't the cause of this cantering issue.

There was pain and tightness around the pelvis - the muscle group (begins with F if i remember rightly) that takes up the space between quarters and pelvis - which Vets felt was more significant.

Decision was made to block the back and see if this makes a difference or provides something to go on. Thats booked for tomorrow.

 

[JGC]

I'm glad you seem to be getting a lot closer to working out what the problem is and hopefully it'll be something not too complicated, fingers crossed

 

[TarrSteps]

Well, not ideal but at least you have a path.

I find longeing in a head collar and, if plikeble, observing a horse loose schooling (not running around like an idiot) to be very useful. Ideally I like to really observe a horse regularly so I know what normal is for that horse and if there is anything that makes me go hmmmm.

 

[HayleyUK]

I'm not allowed to loose school - but do lunge in a headcollar quite often - and try to avoid her sodding off up the arena bucking whilst dragging me along!

Mechanically, it makes sense. There was an issue in the forelimb, which affected the way she moved and likely caused the impingement of the DSPs, this caused further 'pain' or discomfort so she altered her way of going again and has caused an issue further back. It the same when my back, or leg or whatever hurts - i usually get a twinge elsewhere due to a change in the way I use my own body.

To be fair to her- she's never ditched me out of naughty/pain behaviour - she's only ever done it when she's got lit up about something - so if something is niggling her, she's probably going to be pretty easy from a training point of view as she clearly wants to please.

 

[HayleyUK]

Another update - and it isn't positive really!

Vet spent three hours last night never blocking the back - as xrays confirmed impingement - we didn't expect the blocks to be conclusive, but they turned out to be fairly conclusive in that they made no difference whatsoever.

Vet is now thinking that this almost confirms the suspicion that the changes are related to discomfort in one or both hinds. Current thinking is that it is SI or possibly suspensory related. I'm leaning towards PSD.

Petplan have excluded the RH based on two lame steps she took on the lunge at Leahurst that was noted in the report - although they chose not to investigate it as it didn't present again whilst she was there so not sure where we stand with regards to PSD workup/op/treatment.

Options now are:

Turn away for a year - I'm on livery so this could be expensive long term if she doesn't come right and is probably a last resort.
Start blocking the hinds and see what that throws up
PTS
Thermal image
Animal communicator - I'm getting that desperate

Waiting on a call from the vet to discuss further.

 

[maxine1985]

If you can afford it, get hind limbs blocked and scanned, should be under £500, but Petplan should cover 1 hind leg so all costs will be divided by 2

Then turn away, least if its confirmed PSD and scanned you'll have something to compare when you rescan in a year to consider bringing her back into work

PSD doesn't have a good prognosis with rest alone in hind limbs, around 20% full recovery- usually 3 lots of shockwave and PRP therapy would be recommended but without insurance that's likely to be around £2-3000

Cheap grass livery somewhere and time is your best bet if you want to give her a chance -(any horse can adapt to live out 24/7 if sufficiently rugged and fed)

 

[TarrSteps]

Rats.

Blocking shouldn't cost the earth.

Thermal, I have mixed feelings on - it might help you pinpoint an area but it won't specifically diagnose and there is still the issue of what to do.

AC, leaving out the obvious conversation, isn't the horse just going to say she hurts? Which you already know. I know what bits of me hurt but I don't always know why.

Turning away, obviously good places cost but only you can make that choice.

I can't remember, did you try a bute trial? Going to PTS seems quite extreme without even trying the old style methods of dealing with stuff like this.

 

[HayleyUK]

I think PTS is the ultimate worst case - but it was voiced as a potential if its completely unfixable.

No issues with blocking the hinds and scanning - and happy to pay for this, just not entirely sure where we'd start. I've started an appeal process with insurers to see if they'll consider removing the exclusion based on Leahurst's opinion that it was a one off/nothing to investigate etc back in April last year - fingers crossed they'll play ball on this!

I've got a thermal scan booked tomorrow - as wondering if this might throw up an area that we can start to investigate, rather than kicking off blocking 'blind' IFYSWIM?

My gut feeling is that its PSD - She fits all the textbook symptoms. Research seems to be suggesting that unless its a recent injury shockwave isn't really that great - and a better option is one of the two operations offered.
Which kind of negates the whole shove it in the field for a year to come right theory...

Loose plan of action is to see what the insurance say and proceed to blocking either 'on a budget' or taking full advantage of the insurance money - if that throws up nothing, I'll shove her out, possibly look at embryo transfer a foal using her as the 'carrier' for my older mare's foal for 12m and see what happens.

She's from a well known showing stud, and is sound W&T so could have a career as an inhand pony, or even a broodmare if its nothing she'd pass on to a foal maybe?

 

[TarrSteps]

Re blocking, you pretty much have to start at the heel and move up - I can't see a responsible diagnostician starting partway up the leg as if results are positive there is no way to work backwards.

Sounds like you've got lots of options. Good luck

 

[Kelpie]

I have a mare with PSD and have done all the research on it I think a person can do, so if you have any questions, let me know. There is also a really good facebook group for PSD, if you're on facebook, and if you read through prior threads on that it would probably answer most of your questions.

It's true the prognosis for PSD is poor but there is an increasing school of thought that having PSD is normally secondary to another issue that is affecting the horse's way of going (perhaps the KS is affecting your horse's way of going, even if blocking made no apparent difference? or maybe SI pain).

I'm not sure what vets your using but I'd be really tempted to send her off to one of the big vet hospitals for a full on work-up, so you know properly where you are with things.

If it is "just" PSD, then the neurectomy & fascioctomy have a good success rate but if it is PSD coupled with SI pain then the success rate for the operation goes right down to 40%. So to make an informed decision on treatment options, it's massively important not to just stop at a diagnosis of PSD, you really need to find out everything that is going on and then judge from there.

Good luck.

 

[Pigeon]

I'm having the exact same issues. I will follow this thread with interest. Hope it all gets diagnosed and sorted

 

[RachelFerd]

My two-penneth worth... Whatever you do, make sure you send her to somewhere willing to block the SI joint. Not many vets will do this - Sue Dyson will, some others will.

What you do not want to do is to establish that she improves slightly to a sub-tarsal block (which indicates possible PSD) and not realise that there is still a significant component of SI pain which will not be resolved by a neurectomy and fasciotomy.

If the SI responds to the block you may or may not have success with medicating the SI joint. Hate to say it, but in my experience (working horses under saddle for performance work-ups) changing behind is synonymous with SI pain much more so than PSD, although the two do tend to go hand in hand.

If SI pain does not seem to respond to a block, and the sub-tarsal block does not eliminate the problem either, then the prognosis is generally very guarded.

 

[TarrSteps]

Out of curiosity, how would you definitively diagnose SI dysfunction without a response to a block and what would it mean if the SI is involved but does not block out.

Sorry OP, just interested, since we're having the conversation.

 

[RachelFerd]

So - from my one-vet experience If the horse is showing classic SI pain symptoms (any number of them including changing behind, difficulty in flying changes, poor quality canter, cold-backed; tense behind the saddle; reluctance in lateral work) and having blocked the hind limbs pretty much completely (low-four, sub-tarsal, tib-fib and stifle blocks) and having ruled out spine (by x-raying, and if impinging processes shown, blocking the specific areas also)... there are still significant levels of SI pain symptoms shown - this would be the diagnosis of (most probably) having SI pain as the most significant component of the poor performance symptoms. I hasten to add, this is not something that is taken lightly!!

It seemed to me that the more intense the SI symptoms, the less likely they were to respond to the block (ie block wasn't strong enough to eliminate them - it's a very general area block rather than a really precise elimination type block) Since the block is given in the same way that medication would be (as in same injection area and technique) if there is no reasonable response to the block, it is likely there won't be a great response to medication. That said, there have been examples of horses who have responded to regular medication of the SIs that did not respond very well to blocking.

Those that responded to the block seemed, statistically, to respond better to medication.

It is a really difficult puzzle and I do not envy the vets that take it on!!

Also the reluctance by many vets to block the SIs is that in a very small number of horses, it can make them temporarily very wobbly behind with a tiny risk of collapse. Hence the concern about doing it. I rode plenty of horses with the SI block (having established that they weren't having the wobbly reaction) and it is interesting - compared to other blocks, the reaction to it isn't instantaneous - it seems to take a few minutes cantering generally for the block to gradually work - I think because the horse has developed a compromised way of going it takes a while for them to realise that they are able to move more freely. So to establish whether the block has worked, one must ride for a decent enough amount of time before professing that it hasn't worked.

 

[TarrSteps]

Excellent. Thank-you very much.

Are you still riding there?

 

[RachelFerd]

No am not - back in full time racing, got a financially better offer so moved on!

 

[TarrSteps]

Fair enough!

 

[HayleyUK]

Thanks for all the replies - some really useful thoughts and ideas.

To give you another update (because I've bored everyone else senseless with waffling about this).

I managed to get someone out to do a thermal image of little miss SickNote one Saturday - which was fascinating. It threw up some really interesting images which I'll share when I have them. I was pretty skeptical, and was happy to be proved wrong when it threw up hotspots around the old tendon injury - as well as her impinging DSPs where the hair had been clipped. It also threw up some interesting spots on the left hind.

Vets are happy to block SI as far as I'm aware - sending to Sue Dyson isn't really an option for us, as I'm reluctant to travel 4hrs plus to be told to shoot it. Much as she's respected and bowed down to - I honestly can't see how she'd find anything positive to say about this little mare. Leahurst who are known for being slightly more positive about things deemed her return to soundness 'fairly guarded' and were significantly shocked when they scanned the tendon after the rehab by the improvement.

I'm working with Leahurst currently to get an exclusion removed which means we can proceed to investigate hinds on insurance. Aiming to kick things off with a subtarsal block - at some point in the next few weeks and go from there.


Pigeon - is it the pony in your banner that's similar? (s)he looks really sweet, and a bit like my mare, just chnkier