HHO work up please

P

Patterdale

Well-Known Member
Joined
28 December 2009
Messages
7,739
Location
Wherever I lay my hat.
Visit site
I’ll be getting the vet too, but would like as many ideas/differentials as possible first.

15hh 9 year old standardbred x cob. Ex driving horse - he was driving in Ireland at least as a 3 year old, but from what I’ve found out I don’t think he did absolutely masses.

I got him at 4, have had him reasonably fit but never overdone in that time. He’s only been in a school probably 6 times a year or less, I school on hacks.

He’s always been sharp and forward but never difficult or nasty.

In January we moved and I started riding again after 6 months off. He was extremely sharp bordering on explosive/dangerous which I put down to ulcers after being unsettled with the move. After omeprazole improved. Then went downhill again and also became very difficult to shoe behind, where he’d always been fab before.

I got the vet out. He was not lame. Could maybe make him 0.5/1:10 after flexions but even that was pushing it. However, he is a very stoical horse and I knew he wasn’t happy.
X rayed hocks and very mild arthritic changes. Had steroid injections and he was fairly instantly calmer and happy to be shod.

That was 6 weeks ago and he’s now being very difficult to ride again. He isn’t resistant or not wanting to go - he is extremely forward, spooky, tense, and keeps snatching a hind leg up. He is also girthy again.
Physio found lots of tightness lumber region, however he always has that due to his strange action.

So he is obviously uncomfortable. But what do we do now?

X ray back?
Scan suspensories?
Arthramid rather than steroids?

I’m not a bottomless pit but I do want to do right by this horse, he means a lot and he’s a good boy.
 
Do you have any videos you would be willing to share on here of him moving? Lumbar region soreness and snatching up leg would also make me wonder about the sacroiliac joint changes/something higher up the hind end/pelvis, also suspensory ligaments.
 
As a ball park I just had full x-rays done, multiple plates on all four fetlocks, both stifles, both hocks and his spine wither to tail and it has come in at £500 + VAT.
The ultrasound on the stifle was £320 + VAT, so I imagine similar on the suspensory region

I wouldn't arthramid without knowing what's going on. I would probably x-ray hind stifles, lumbar spine and fetlocks as you have already done the hocks. I don't think it would break the bank and would give you some indication on where to start looking
 
You're pretty much describing Charlie, even down to the reluctance to pick up a back leg. I sent him for a full work up. He was 100% sound in all 4 legs even when using the lameness locator but the vet believed me when I said his behaviour issues weren't 'just' behaviour. He x-rayed his back, stifles and hocks. Stifles and hocks were perfect but he had 3 spinal processes that were very close. The vet thought they were catching intermittently under certain conditions (including lifting back legs) rather than causing constant pain which accounted for the sudden reactions that would be over as quickly as they began. He had the area medicated, did his rehab, got sold (we'd lost faith in each other) and is now doing brilliantly with his new owner.
 
Miss_Millie said:
Do you have any videos you would be willing to share on here of him moving? Lumbar region soreness and snatching up leg would also make me wonder about the sacroiliac joint changes/something higher up the hind end/pelvis, also suspensory ligaments.
Click to expand...
Having had similar descriptions of last 2 horses ( pure standies though) I would xray lumbar region and MRI SI
 
Hi Patterdale

My thoughts whilst reading your post was the diagnosis by your vet was too narrow. I appreciate now with hindsight that’s easy to say. Mild changes in the hocks and the ulcers flare up do suggest more going on and makes me feel the hocks were compensating. I think you need an orthopaedic vet that will look at the whole body rather than X-rays lots of different things etc.
 
While looking at the body, also have a look at the legs. Is he feathered ? If so can you get them clipped to check for CPL and mites? Even if he isn’t itchy it could still be an issue. My Cpl cob has very snatchy back legs and it’s just because they’re so sensitive.
 
I’d take him for a full work up with a good lameness vet.

It could be any number of things and very likely a combination of issues now such as ulcers on top of orthopaedic issues and compensation from moving wonkily. You could spend ages firefighting bits and bobs otherwise.

I second that short lasting hock steroid injections could indicate PSD. The steroid helps to soothe the hind suspensories for a short time post hock medication. That is how my homebred junior eventer reacted, we got her pasture sound but she was retired from being ridden as a 7yo.
 
The description is more like my horse which had hind suspensory problems, he was always quite forward and became sharp and spooky and tended to do a few bucks after a big spook. Because it was bilateral he wasn't obviously lame until one suspensory was blocked.

I have one atm who had a fall and sustained an SI injury. He went stuffy and backwards, didn't track up and looked generally stiff in his hindquarters. I'd seen him fall so it was easier to know what was going on.
 
I’ve had something similar in the past and we ended up doing a full body scan. Expensive, but you could spend just as much trying to locate potential multiple issues.
 
nutjob said:
I have one atm who had a fall and sustained an SI injury. He went stuffy and backwards, didn't track up and looked generally stiff in his hindquarters. I'd seen him fall so it was easier to know what was going on.
Click to expand...

How was that diagnosed, through an ultrasound? Am I right in thinking you can't x-ray the SI because there's too much muscle mass around it? Hope he is okay now!
 
Miss_Millie said:
How was that diagnosed, through an ultrasound? Am I right in thinking you can't x-ray the SI because there's too much muscle mass around it? Hope he is okay now!
Click to expand...
It wasn't diagnosed with imaging, I saw him fall and the hind legs did the splits and he really struggled to get back up. A hock and fetlock were swollen which did resolve without treatment but once they were OK he was still not moving properly and the physio found he was painful over his SI. The vet knew him well and could see that despite not being specifically lame he just wasn't moving as he use to, a bit waddling / shuffling. We tried some rehab exercises and tens treatment but it wasn't working so the vet injected the SI and there was an immediate improvement. We continued with the physio and he returned to full work. He had a follow up injection about 4 years later as the physio found soreness in the area again, but it's manageable. I think the outlook is worse if its from wear and tear / degeneration rather than a specific injury.

I think typically it's diagnosed by behavioural changes, loss of performance, bunny hopping canter and ruling out other things. They can do a rectal ultrasound but I didn't have this as it was fairly certain what the problem was and I didn't need the bill hiking up any more!!
 
nutjob said:
It wasn't diagnosed with imaging, I saw him fall and the hind legs did the splits and he really struggled to get back up. A hock and fetlock were swollen which did resolve without treatment but once they were OK he was still not moving properly and the physio found he was painful over his SI. The vet knew him well and could see that despite not being specifically lame he just wasn't moving as he use to, a bit waddling / shuffling. We tried some rehab exercises and tens treatment but it wasn't working so the vet injected the SI and there was an immediate improvement. We continued with the physio and he returned to full work. He had a follow up injection about 4 years later as the physio found soreness in the area again, but it's manageable. I think the outlook is worse if its from wear and tear / degeneration rather than a specific injury.

I think typically it's diagnosed by behavioural changes, loss of performance, bunny hopping canter and ruling out other things. They can do a rectal ultrasound but I didn't have this as it was fairly certain what the problem was and I didn't need the bill hiking up any more!!
Click to expand...

That makes sense, thanks for explaining! I always find threads like this to be very educational. I'm glad to hear your boy was still able to continue mostly as normal after the SI injections.
 
Update, had the vet today.

Not lame, even with flexions. Not even 1:10…but he is very tough!

Very reactive over his back, very tense all over.

Suspensories looked ok, but one area of kissing spines on x ray. We’ve medicated his back and will try a muscle relaxant to aid recovery. I’ve never had anything with kissing spines so this is new territory for me!
 
Glad you have answers! I hope he’s feeling much better soon.

I do know that rehab can be successful - I have known of two personally - one medium in terms of symptoms and one severe (true bolting). Both were still happy in work many years later.
 
Patterdale said:
Update, had the vet today.

Not lame, even with flexions. Not even 1:10…but he is very tough!

Very reactive over his back, very tense all over.

Suspensories looked ok, but one area of kissing spines on x ray. We’ve medicated his back and will try a muscle relaxant to aid recovery. I’ve never had anything with kissing spines so this is new territory for me!
Click to expand...
I thought this is where this was going. Like I said, everything you were describing was exactly the same as Charlie. He too had his back medicated. We had lost faith in each other and when the time came to get back on him, I really didn't want to so I sent him off to rehab then sales livery with full disclosure and access to all his vet records. He found a great new home and is now out eventing at 90, about to do his first 100. He needed his back medicating to calm the inflammation and pain but since then, with attention to having him working properly over his back, he's not needed anything more doing to it. Hope you get the same results.
 
You must log in or register to reply here.
Top