Horse and rider with extreme issues...

[Michen]

So - this is based on my experience as a rider for poor performance work-ups at the AHT.

After an initial assessment on the lunge and under saddle, you pick the most suspect leg, and start by blocking up that leg gradually. So starting by blocking foot, then pastern, then fetlock, then hock. If the horse doesn't engage well, then you'd probably be picking a hind leg to start with. What will often happen is that with nerve blocks (usually once you're covering hocks and suspensories) the leg you haven't blocked will start to appear lame as the blocked leg improves.

You then move on to blocking the other hindleg - so this will usually then level out any unequalness you have created.

Then, quite often, because the horse is moving better behind, you'll then be able to sport some unlevelness in front and work to block that too.

By doing each assessment after each block under saddle, the rider can report back on what they feel - not just visible lameness. So you're getting input on how the contact feels, the horses willingness, their ability to flex and bend, their desire to go forwards and step under etc.


If by blocking the limbs the horse still isn't going sufficiently well, nerve blocks into the sacroiliac and into spinous processes can also show if there are problems there that are impacting performance.

The good thing about doing nerve blocks under saddle is that you are looking for the root cause of the ridden problems - rather than looking for things on imaging which might end up being just coincidental.

After hte blocking process, there will be short list of areas of the horse to do further imaging on - which is probably a combination of x-ray, ultrasound... and then MRI if the first two haven't shown anything clear.

At 70-100 quid per block depending on the block, that could rack up very quickly unless you get the right leg and right block early on. Bone scan circa £1000 depending on where you go.

 

[RachelFerd]

At 70-100 quid per block depending on the block, that could rack up very quickly unless you get the right leg and right block early on. Bone scan circa £1000 depending on where you go.

Honestly, the bone scan was often performed at the AHT because referring vets wanted one - but they were usually a total waste of time. You have no idea if the things you see on the bone scan have got anything to do with the ridden issues - so you still have to go through the complete blocking process if you want an accurate answer. The only logic to using the bone scan is if you've got a horse who can't be worked hard enough to go through all of the blocks.

You're not going to get a vet to do a poor performance work-up properly and thoroughly at home - it's a job for a clinic. It has to be done thoroughly, starting from the foot and working gradually up each leg, else it is random pot-luck and throwing money at chance.

Having sent horses of my own in for poor performance work ups, the cost of assessing through blocks has always been less than the cost of a bone scan. Remember nuclear scintigraphy means horse has to stay on site for minimum of 2 days, and since they are radioactive on day 2, they can't do any actual further analysis, so that extends the stay on site at hospital even further.

 

[palo1]

Yes, it is tricky to know where to go really. For me, at least, the horse has had ulcers and that would be my restarting point - primarily to try to track down what is causing them. As it is something that doesn't cause 'lameness' as such nor any apparant discomfort with back, neck then you have to think of all the 'silent' things it could be; potentially hind suspensories, muscle related issues, internal/digestive issues etc. But you do need a really good vet to do this within what can be paid for and coped with by the owner; that is the really difficult and often limiting factor. The other thing to bear in mind is that the owner (generally speaking) usually wants not just answers but resolution too. I know that my friend definately wants a horse to ride at the end of this so there is more motivation to look for things that can potentially be fixed than to just look for answers iykwim. The whole thing has spooked me most horribly as this scenario is one we all dread

 

[Michen]

Honestly, the bone scan was often performed at the AHT because referring vets wanted one - but they were usually a total waste of time. You have no idea if the things you see on the bone scan have got anything to do with the ridden issues - so you still have to go through the complete blocking process if you want an accurate answer. The only logic to using the bone scan is if you've got a horse who can't be worked hard enough to go through all of the blocks.

You're not going to get a vet to do a poor performance work-up properly and thoroughly at home - it's a job for a clinic. It has to be done thoroughly, starting from the foot and working gradually up each leg, else it is random pot-luck and throwing money at chance.

Having sent horses of my own in for poor performance work ups, the cost of assessing through blocks has always been less than the cost of a bone scan. Remember nuclear scintigraphy means horse has to stay on site for minimum of 2 days, and since they are radioactive on day 2, they can't do any actual further analysis, so that extends the stay on site at hospital even further.

Fair enough but I think often there is more benefit having them done at home. Often the extra adrenaline being away masks a problem that may show up at home. I’d rather my horse was pulled from the stable relaxed and in a normal routine where the issue was consistent, assuming facilities allowed for a work up. My vet seems to agree.

 

[ihatework]

^^^
It’s not cut and dried what is the best approach, often only hindsight gives you that! Bone scans are a useful tool but not something I’d do from the outset. From experience working a horse up at home is generally frustrating, time consuming and works out more expensive.

If I think I have an issue I get a orthopaedic vet with a very good performance eye to look at home. They generally have a gut feel of the problem area and they get one shot to block an area and image. No improvement then the horse 100% goes to the clinic to be worked up from the bottom up. No way do I pay for that to be done at home.

 

[RachelFerd]

Fair enough but I think often there is more benefit having them done at home. Often the extra adrenaline being away masks a problem that may show up at home. I’d rather my horse was pulled from the stable relaxed and in a normal routine where the issue was consistent, assuming facilities allowed for a work up. My vet seems to agree.

I don't think a satisfactory poor performance work up can ever be done at home. It takes all day to work through blocks properly - no vet has the time to do that on a visit, but at a clinic when there are 4 horses all being worked through on the same day, it makes much more sense.

If there's a strong suspicion that there's something specific, then by all means block at home if you've got a good sense of the area. But if, like in the case of this horse, you have a sound looking horse that isn't performing, then the full work up becomes the only option. Adrenaline soon disappears when they are being ridden for the 10th time that day....

 

[palo1]

I don't think a satisfactory poor performance work up can ever be done at home. It takes all day to work through blocks properly - no vet has the time to do that on a visit, but at a clinic when there are 4 horses all being worked through on the same day, it makes much more sense.

If there's a strong suspicion that there's something specific, then by all means block at home if you've got a good sense of the area. But if, like in the case of this horse, you have a sound looking horse that isn't performing, then the full work up becomes the only option. Adrenaline soon disappears when they are being ridden for the 10th time that day....

I simply cannot imagine this particular horse tolerating being ridden that much; it would become an impossible situation I fear. I hope that another avenue of investigation reveals what the problem is tbh. His owner certainly would not want to be the one to try to ride him through a ridden performance work up...

 

[DirectorFury]

Totally left field but something about this is setting off neck arthritis alarm bells for me. Has he had any neuro assessments, and does he have a large % of TB blood?

 

[fredflop]

It sounds to me a though a poor performance work up would be the best thing to start with, if the owner is happy to pay for it.

 

[milliepops]

Yes, it is tricky to know where to go really. For me, at least, the horse has had ulcers and that would be my restarting point - primarily to try to track down what is causing them.

this makes sense to me. My horse diagnosed with ulcers this winter raised question marks about why she got them, but the way we looked at it there was no potential to work up anything else until she was comfortable enough to be ridden/lunged etc. the behaviour was so challenging that it would have been impossible to do much else before they were settled down.

 

[milliepops]

Totally left field but something about this is setting off neck arthritis alarm bells for me. Has he had any neuro assessments, and does he have a large % of TB blood?

I also thought of this because of the shutdown-ness and clumsiness.

 

[RachelFerd]

I simply cannot imagine this particular horse tolerating being ridden that much; it would become an impossible situation I fear. I hope that another avenue of investigation reveals what the problem is tbh. His owner certainly would not want to be the one to try to ride him through a ridden performance work up...

No - that's why the big places employ good riders specifically for riding through performance work-ups. Our job was not to push horses hard - it was to give clear feedback to the vets on the differences we could feel and help ensure that we were objective and fair in our assessments. I rode all sorts of horses - from olympic event horses through to grand prix dressage horses, FEI ponies, happy hackers and arab endurance horses.

Most of the horses that arrived were at the end of a very long road of wasted money on saddles, physios, endless ulcer investigations, sent away to professionals etc. etc.

I do still believe that even after you resolve physical issues, there are longstanding behavioural issues that often need to be worked through - pain is lessened, but learned behaviour still needs working through. And then horses also need to be re-strengthened up again.

 

[palo1]

Totally left field but something about this is setting off neck arthritis alarm bells for me. Has he had any neuro assessments, and does he have a large % of TB blood?

Basic neuro assessments (for wobblers for eg) all clear. He certainly doesn't present as being potentially 'neurological' but the good local vet did check that out not long after problems began. Not a huge amount of TB blood present there either.

 

[Meowy Catkin]

Can you show the owner RachelFerd's posts?

 

[palo1]

No - that's why the big places employ good riders specifically for riding through performance work-ups. Our job was not to push horses hard - it was to give clear feedback to the vets on the differences we could feel and help ensure that we were objective and fair in our assessments. I rode all sorts of horses - from olympic event horses through to grand prix dressage horses, FEI ponies, happy hackers and arab endurance horses.

Most of the horses that arrived were at the end of a very long road of wasted money on saddles, physios, endless ulcer investigations, sent away to professionals etc. etc.

I do still believe that even after you resolve physical issues, there are longstanding behavioural issues that often need to be worked through - pain is lessened, but learned behaviour still needs working through. And then horses also need to be re-strengthened up again.

Yes. It is very depressing really isn't it? I am not sure I would have the energy and heart for the remaining behavoural stuff after 18 months of unmitigated worry, disappointment and safety issues.

 

[palo1]

Can you show the owner RachelFerd's posts?

Owner is currently pretty fragile but as she moves through the process of investigation I will suggest her asking the vet about a full performance work up. At the moment she is struggling to accept where she is at.

 

[ycbm]

Wouldn't waste money on scintigraphy (bone scan) - poor performance work up using nerve blocks *under saddle* and ultrasound of hind suspensories is cheaper and more accurate. Scintigraphy usually throws up a load of false positives and is only really of use when you've got something very acute going on which is causing you to not want to nerve block under saddle.

Really interesting, thank you, I will modify my opinion of them.
.

 

[RachelFerd]

Really interesting, thank you, I will modify my opinion of them.
.

Would add - I am not a vet, and my opinion is based on those of the vets I worked with. But I think the basic logic of 'if an issue only shows up fully under saddle, you need to test whether what you have found resolves the issue under saddle' is strong. There was one case I remember where the horse's lameness was too acute for going through nerve blocks, and the mystery lameness turned out to be a tiny fracture somewhere in the knee joint. That was found through bone scan. What bone scan couldn't see is that the horse then came back months later with continued poor performance, which was ultimately something else (PSD, or SIs, or both - can't remember!)

I also subscribe to the view that you shouldn't go looking unless you're trying to find something. Horses rarely have totally clean x-rays and scans - the challenge is knowing what is causing problems, rather than what is visible. Sometimes quite big visible problems on imaging don't seem to be causing the horse any issues at all.

In this horse's case, it sounds like owner is at the point where she *is* trying to find something - and therefore, the way you go looking should be a logical process, rather than a scattershot approach. And then there's a layer of behavioural rehab to get sorted on top of anything physical that may/may not exist.

If I was a betting person I'd put money on PSD and/or SI pain - knowing that both of those, if significant, could lead to ulcers anyway.

 

[palo1]

Would add - I am not a vet, and my opinion is based on those of the vets I worked with. But I think the basic logic of 'if an issue only shows up fully under saddle, you need to test whether what you have found resolves the issue under saddle' is strong. There was one case I remember where the horse's lameness was too acute for going through nerve blocks, and the mystery lameness turned out to be a tiny fracture somewhere in the knee joint. That was found through bone scan. What bone scan couldn't see is that the horse then came back months later with continued poor performance, which was ultimately something else (PSD, or SIs, or both - can't remember!)

I also subscribe to the view that you shouldn't go looking unless you're trying to find something. Horses rarely have totally clean x-rays and scans - the challenge is knowing what is causing problems, rather than what is visible. Sometimes quite big visible problems on imaging don't seem to be causing the horse any issues at all.

In this horse's case, it sounds like owner is at the point where she *is* trying to find something - and therefore, the way you go looking should be a logical process, rather than a scattershot approach. And then there's a layer of behavioural rehab to get sorted on top of anything physical that may/may not exist.

If I was a betting person I'd put money on PSD and/or SI pain - knowing that both of those, if significant, could lead to ulcers anyway.

This is very interesting and helpful thank you I will keep this for an appropriate moment to share.

 

[PapaverFollis]

I think there's 3 routes out of a situation like this.

A.Pass the horse on to someone that wants it. Even if that means the horse then doesn't get something investigated that it should and maybe ends up in sh*t state. Some control can be exerted, theoretically, by passing on as a loan.

B.The full workup under saddle/nerve blocks etc as RachelFerd describes, with scans and scintigraphy and everything. Lots of money and emotional energy. Might find a problem. Might not be able to fix the problem. Then what? PTS? Retire?

C.Take the shoes off, chuck it in a field/track/rehab livery for a long period. Let the feet function as feet. Let the horses just be a horse. Re-start and bring back into work slowly as carefully. If that doesn't work, field ornament or PTS.

I think if I could afford it I would scan for a suspensory issue then take option C. I'd kind of prefer option A but I think my conscience would get the better of me. Option B is probably best money allowing but I would never expect that of anyone because it's not realistic. And I couldn't do it.

Oh and of course Option D is PTS without further investment. I wouldn't blame anyone for going there either. If it's lame, in pain or just not right mentally then for me that is always justifiable.

 

[palo1]

I think there's 3 routes out of a situation like this.

A.Pass the horse on to someone that wants it. Even if that means the horse then doesn't get something investigated that it should and maybe ends up in sh*t state. Some control can be exerted, theoretically, by passing on as a loan.

B.The full workup under saddle/nerve blocks etc as RachelFerd describes, with scans and scintigraphy and everything. Lots of money and emotional energy. Might find a problem. Might not be able to fix the problem. Then what? PTS? Retire?

C.Take the shoes off, chuck it in a field/track/rehab livery for a long period. Let the feet function as feet. Let the horses just be a horse. Re-start and bring back into work slowly as carefully. If that doesn't work, field ornament or PTS.

I think if I could afford it I would scan for a suspensory issue then take option C. I'd kind of prefer option A but I think my conscience would get the better of me. Option B is probably best money allowing but I would never expect that of anyone because it's not realistic. And I couldn't do it.

Oh and of course Option D is PTS without further investment. I wouldn't blame anyone for going there either. If it's lame, in pain or just not right mentally then for me that is always justifiable.

I would see it the same as you. I don't think at this point I could pass the horse on. He really doesn't deserve more upheaval and lack of resolution to his issues. If the horse were mine I would probably re-treat the ulcer symptoms (horse is behaving as he did prior to ulcer diagnosis) whilst also arranging for suspensories scan. If that scan was positive I would, in all likelihood proceed thinking and hoping that was the way forward and that with healed (if possible) suspensories, ulcers may not recur; it would probably be a very extended and cautious rehab. I would take off the shoes too.

I would be desperately hoping not to get to plan B because if I were at that point I would have no money to do it anyway and would have to go for Plan D (PTS) in all likelihood I don't think my friend would consider unshod as a way forward though shoes may be off as part of rehab.

I really feel her frustration and disappointment too and keep guiltily sneaking off to enjoy riding my (currently healthy - eek) horses...Riding with this horse is really not for the faint hearted as either horse or rider is constantly at melt-down point and it is all very 'charged' with angst on everyone's part. I really, really, really, really hope that there is progress one way or another very soon. I suspect that if ulcer meds work again no further investigation will happen unless the vet advises that (I would hope vet does but you never know).

 

[RachelFerd]

I think there's 3 routes out of a situation like this.

A.Pass the horse on to someone that wants it. Even if that means the horse then doesn't get something investigated that it should and maybe ends up in sh*t state. Some control can be exerted, theoretically, by passing on as a loan.

B.The full workup under saddle/nerve blocks etc as RachelFerd describes, with scans and scintigraphy and everything. Lots of money and emotional energy. Might find a problem. Might not be able to fix the problem. Then what? PTS? Retire?

C.Take the shoes off, chuck it in a field/track/rehab livery for a long period. Let the feet function as feet. Let the horses just be a horse. Re-start and bring back into work slowly as carefully. If that doesn't work, field ornament or PTS.

I think if I could afford it I would scan for a suspensory issue then take option C. I'd kind of prefer option A but I think my conscience would get the better of me. Option B is probably best money allowing but I would never expect that of anyone because it's not realistic. And I couldn't do it.

Oh and of course Option D is PTS without further investment. I wouldn't blame anyone for going there either. If it's lame, in pain or just not right mentally then for me that is always justifiable.

I think you've summed it up pretty well. Option B only really exists if you have deep pockets, or insurance that you haven't already run out of time on.

Option C is probably where I'd end up, but that would be on the basis of knowing that I still might not have a horse that wants to do the same things as I do at the end of it.

And attached to both option B and option C is that there's *still* probably a layer of reschooling to get past whatever memories the horse has about life thus far.

Edited to add - with my event horse I ended up doing B and C (although his temperament was brilliant, his performance had tailed off) - the B option took place 9 months after issues started coming up, so I was able to put through insurance. Revealed lots of problems (3x limbs with PSD, secondary SI problem) - so treated as per vets instructions, but then also turned away for 18 months, gave the horse a long time without shoes and brought back into work very slowly. Obviously doesn't compare to the OP because I was starting with a horse that had such a good temperament it made sense to try everything. it did work - and he's progressed up the levels since.

 

[palo1]

I think you've summed it up pretty well. Option B only really exists if you have deep pockets, or insurance that you haven't already run out of time on.

Option C is probably where I'd end up, but that would be on the basis of knowing that I still might not have a horse that wants to do the same things as I do at the end of it.

And attached to both option B and option C is that there's *still* probably a layer of reschooling to get past whatever memories the horse has about life thus far.

Edited to add - with my event horse I ended up doing B and C (although his temperament was brilliant, his performance had tailed off) - the B option took place 9 months after issues started coming up, so I was able to put through insurance. Revealed lots of problems (3x limbs with PSD, secondary SI problem) - so treated as per vets instructions, but then also turned away for 18 months, gave the horse a long time without shoes and brought back into work very slowly. Obviously doesn't compare to the OP because I was starting with a horse that had such a good temperament it made sense to try everything. it did work - and he's progressed up the levels since.

That is great to hear that it worked for you It must have been helpful but also worrying to know exactly what the issues were and lovely for your horse that he was given enough time of his own to truly rest and recover.

 

[Ample Prosecco]

RachelFerd, can I just say that was really, really interesting. I have bone scanned twice and neither time was very helpful. And as you say both needed 3 days in hospital. I might have got more from a performance work up. So thanks for posting.

 

[paddi22]

yes thats fantastic information Rachel.

 

[SEL]

RachelFerd, can I just say that was really, really interesting. I have bone scanned twice and neither time was very helpful. And as you say both needed 3 days in hospital. I might have got more from a performance work up. So thanks for posting.

I also found it very helpful. I was practically on my knees pleading with vets to assess under saddle because she looked 'ok' until a rider got on her. In the end I changed vets and sent them a video of my issues - but by that time x,y,z was ruled out from the insurance so the investigations ended up being more scattergun than they needed to be if I'd had vets follow this more logical approach from day 1 (& that was with a known PSSM diagnosis)

 

[Gingerwitch]

RachelFerd, can I just say that was really, really interesting. I have bone scanned twice and neither time was very helpful. And as you say both needed 3 days in hospital. I might have got more from a performance work up. So thanks for posting.

Me to. RachelFerd thank you for taking the time to reply with such matter of fairness. Really appreciated and most useful to many.
Thank you

 

[ycbm]

Another thank you to RF for some seriously useful information. It's all gone in my databank!
.

 

[RachelFerd]

Another thank you to RF for some seriously useful information. It's all gone in my databank!
.

It was a well spent 18 months of my life - terrible pay, but fascinating opportunity to bend the ear of top vets and ride very smart (but also broken) horses every day. Glad to share some of it!

 

[palo1]

If I can and my friend can move forward I will suggest this route in fact Really good to know (hoping I don't need to use this information personally now!!) Thank you.