Ongoing lameness issues - 2nd vets opinion

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I am posting this on behalf of a friend so apologise if I can't answer any queries quickly. She really would appreciate any advice, thoughts or ideas of a vet in the South West for a second opinion or fresh set of eyes.

This is going to be quite long so I will put the basics down.

13 yr old 16.2 Holstein gelding has been lame now since before December and is not getting any better.

A bit of history to this though - Eventing one day in 2011 and went hopping lame during dressage warm up, then instantly sound again. Did this three times over following few weeks.
About a month later, he refused to go into the start box and then had to make up time on course. When he came back he had a bony growth in the side of his splint bone but this was not hot to touch or sore.

He kept going intermittently lame, suddenly when trotting he would go lame and then within ten minutes be sound again! This went on for quite a while and the vets kept turning him away as it could not be replicated at the clinic.

Finally he went lame and stayed lame. Vets nerve blocked him and he blocked sound to his coffin joints. He decided to do IRAP therapy and after a few weeks this seemed successful as he then went sound and stayed sound for about 18 months.

In November/December 2012, having not done hardly any work, he went lame, mildly noticeable at first but then was clearly lame in trot. Vet advised that his feet were bruised and recommended we try remedial shoeing, we did this for three sessions and although the were improvements, this does not solve the issue.
X-rays were done and these were normal, in fact excellent! Treatment in the form of steroid injections to the joint followed, which again did not work. More blocks were done and he blocked sound to the bursa. Steroid injections were done into the bursa but this did not work either. An MRI was done but this was unremarkable!

He has now just undergone 5 weekly rounds of IRAP. After the forth one, he was almost sound, however, less than a week later, he was suddenly very lame, even in walk! This he has never been. He was taken straight back to the vets, who stated that he was very sore to the toe with hoof testers ? He was reshod and a further IRAP done. He isn't quite as lame in walk but still obviously lame in trot!!

If anyone has any suggestions of what to try next we would be extremely grateful. Or recommendations on a good lameness specialist, although he has been seen and treated by a fairly well recommended one already.
 
My lad had lameness that blocked to the coffin joints.

It also started perhaps a little like your friends although it was surface dependent. We lost our extensions for a couple months previously and there were a couple of occasions on a surface (usually work on grass at home) that I felt he was a little bit off but not completely lame... def went lame once but then improved during a lesson.

I presume as MRId xrays were taken, is the pedal bone in a normal position and what do the feet look like? The unremarkable MRI doesn't really help but he is obviously feeling something.

Mine had remedial shoeing and steroid injections into the coffin joint but although the feet looked better they didn't improve his soundness.

I took his shoes off and got some specialist help. Spent a few months walking and he has been sound for the last year (now 20) is this something your friend has considered. Mine also had flat pedal bones/flat soles and didn't land straight (laterally therefore putting extra pressure on the joint). IMO although the shoeing improved the outside look of the feet it hadn't helped the internal structures- once they had strengthened the foot was able to function better and support the joint. - We now have feet with concave soles, no longer have a bull nosed profile and no under run heels. Importantly he also lands much straighter in front so not putting the sort of continual strain on collateral ligaments that he was before (we didn't MRI but having seen his movement I'd be surprise if not chronically strained!)

It's been a learning curve and we now do a few things differently management wise but I am delighted to have the lad back :). It was that or retirement as far as I was concerned and he wasn't having shoes on for retirement ;).

I'm no expert and have just been learning as we have gone along but I think it is certainly an option worth your friend considering as traditional therapy doesn't seem to have give a long term improvement.
 
It depends who is already involved, Sven seems to be about the best in the area with good diagnostics available which not all vets have access to.
If nothing showed on MRI, presumably you have already been there for this, I would think the next course of action may be to look at Rockley, it is in the area if all the usual routes have so far failed to either find the reason for lameness or to treat, they have great success with difficult cases and I think Nic is happy to have a chat about cases without committing to sending the horse.

How is your horse doing?
 
Thanks. This horse has been looked at by Sven already. I have mentioned Rockley to her so this may be next course of action.

My lad goes back for his check up on thursday so fingers crossed there is improvement and he can come off box rest and start in hand rehab work. Thank you for asking.
 
I have not dealt with Sven directly but from contacts who have I do not think you will get anyone better in this area, most smaller practices refer there , Rockley is certainly a good option.

Pleased yours is doing ok:)
 
Our WB has had steroid and hyloronic injections to his coffin joints x 3 since December 2011,combined with two courses of adequan. His last treatments were September 2012,when the insurance maxed out.With careful management and the use of extraflex with rose hips,and now zero bute as the ground is hard,he is so far sound and back to jumping.He has natural balance shoes which have been effective (vet and farrier advise this against barefoot) and i stable him at night to minimize collateral damage from hard ground.I can only think it is difficult when you don't have a definitive diagnosis,as so far investigations seem to rule out certain conditions.Would it be worth getting a back specialist to examine him in case the problem is originating somewhere else?
 
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