Recurring problems - WWYD

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Wheels

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This might be long
I have a horse who has just been a little ‘off’ for quite a while – went through a few bucking episodes but generally just not very forward, a little stiff at the start of our rides (he’s only 7) and going from a horse who enjoyed working and especially enjoyed lateral work to a horse who doesn’t really want to go forwards, sideways or backwards and is reluctant to really put much effort in at all. He is also tail swishy and resistant to most things I ask him to do although does have the odd good day where he is excellent. He was diagnosed with lumbar kissing spine – only just touching, no overlap between L1, L2 & L3 but I just can’t help thinking that this is a symptom of something else, we went through re-hab and physio work prescribed by the vet earlier in the year but he just couldn’t seem to stand up to the work longer term. I suspected SI issues but not diagnosed as no lameness showing etc.
This has been going on for some time now, been to a couple of different vets and physios to try and sort things out but our rehab programme just isn’t working. The problems can be quite intermittent, some days he looks great and others (more frequently now) his posture changes and I can tell he’s not happy, gets spooky when otherwise not the type and doesn’t really want to do anything other than stand and eat. He only saw the physio last week (approx. 4 weeks since previous visit) and he was sore in his deep muscles around shoulder joint area on the right and also tight and sore on his left lumbar area. He showed improvement over the weekend and was happy in his light exercise on Monday / Tuesday with a day off yesterday. This morning he’s sore and tight in his right shoulder and left lumbar area again. This is a bit of a pattern and I don’t think we are getting very far in trying to sort it out.
So – vets here we come but not really sure what approach to take.
So far he’s had:
Full lameness check (not blocks) in straight lines, lunge pen, hard surface, soft surface, flexion tests = no lameness. He’s now been trotted up for several vets and physios and nobody can spot any type of lameness
Suspected ulcers – scoped and definitely no ulcers
L1-L3 KS diagnosed
Physio suspected SI issues as did I and we have been working to build up muscle in this area and he was improving on a daily basis and then the last few weeks we’re having recurring muscle issues
I’ve sent a hair sample for PSSM although I don’t think it’s that but just wanted to rule it out – awaiting results, should be back with me next week

He doesn’t want to really step under himself with either hind but definitely not the left and he is clearly not happy about doing shoulder in (in hand) or any other type of lateral work
So all sorts of things are going through my head – is it his shoulder? SI? Still KS alone or with something else? Suspensories? PSSM?
What would you do next? Physio just thinks he’s hoolied around the field and slipped or something but this to me is a recurring issue that I never seem to be able to get sorted 
 
just going on the horses i've seen that have been like this, I'd want to block the hind legs. If there's a bilateral problem many people won't spot a lameness until you block one leg. Suspensories +/- spavins and SI would all be possibilities IME, especially since you already know about the KS, as they all go hand in hand quite often. It's quite possible the pain in the foreleg is a result of trying not to overload something behind (esp asl you already suspect left hind and he's sore left lumbar area), have seen that before.

Sorry you're going through this, it must be so demoralising to see your horse not right despite your efforts.
 
It's awful, demoralising and frustrating and I feel so bad for the wee man because he's got such a good nature and even through all of this he's never once put his ears back, tried to bite or kick out at any of the prodding and poking!!

I've also now lost trust in the vet who diagnosed his KS - not that I think there was anything wrong with the diagnosis but being constantly told to push on when I know he's not right means I now need to find another vet.

That isn't easy to know who to trust - all of the recommended equine vets have missed stuff and dismissed me when I know things are not as they should be so I feel quite lost at the moment
 
whereabouts are you? Perhaps someone would be able to recommend a good person to go to with your concerns.
I know who I'd ask at my practice - they are all good horse vets but there are a couple who would be the specialists in this kind of thing.

I think you have to push a bit harder on this, you know your horse so don't let them fob you off. It does sound a lot like a couple of horses I've known and there was a lot of advice to just push on, UNTIL nerve blocks were done and the actual problem was revealed.
 
I'm in Northern Ireland - I'm not sure there really is a 'lameness specialist'

to my knowledge none of the equine specialists have scintigraphy or MRIs so maybe I need to go down South or transport him to England
 
Try Bruce Steele (I think he's Newry direction), he's actually who I'd go to for a lameness specialist, and I'm in the south.
 
I was looking at Troytown in Kildare as they have MRI and bone scanners if it comes to that - do you know of them Cortez?
 
Yes, Troytown are very spiffy :-) They do a lot of racehorse business. You could also try Ned Goings on the Curragh (not sure what machines they have), or Lissadell in Meath, near Navan.
 
I was about to say get someone who does lots of racehorse lameness, they will have the kit and their eye in- big vet hospital is what you want
 
From your description I would be surprised if it is not PSSM. However the hair test is only going to tell you if its type 1 or not. There are other types which it doesn't cover. Have you had blood taken from him. If so are his enzymes within the normal range or not? Some PSSM horses can have normal enzymes so it's not a fail safe way. However I just had an Irish horse vetted and he had raised enzymes so I did not buy him. Out of two horses I've looked at in Ireland one has PSSM type 1 and the other has a high chance of it too (I did also do a hair test but it got lost in the post and I still haven't had the results but even if he's clear of that I believe he has a muscle myopathy of some sort). This leads me to think it's a much more common problem than even my paranoid self had suspected.
 
FfionWinnie - would enzymes be checked on a standard blood panel? And are they only raised after exercise?

We did take bloods a couple of times at the start of this process and everything was in the 'normal' range apart from platelet counts being slightly up

but if enzymes are not checked through the normal panel then I can ask for this to be done
 
Looking back at my notes - sorry it was slightly raised haemoglobin, slightly low platelets and slightly raised Albumin

I am not sure if any of these are significant in terms of PSSM but my vet didn't seem worried
 
With an intermittent, nonspecific lameness paired with sluggish behavior I might have him tested for Lyme disease too!

Before you go and do a full body MRI, I would test for Lyme and then ask your vet about an SI injection. Improvement or sameness will help you rule out some physical causes, probably cheaper than jumping to MRI.
 
Wheels said:
Looking back at my notes - sorry it was slightly raised haemoglobin, slightly low platelets and slightly raised Albumin

I am not sure if any of these are significant in terms of PSSM but my vet didn't seem worried
Click to expand...

It would be the AST and CK levels. This horse I just vetted was above the normal range on both before exercise and CK shot up after. My vet mentioned she just tested an endurance horse which did 150 miles and her levels were perfect before and after. She would be very suspicious of any increase in a horse in normal work. Now it definitely would not rule it out if his levels were normal but if they aren't it would make it something to investigate further.

Agree about Lymes testing as that can offer similar symptoms to PSSM.
 
I've no idea sorry. Until I got my mare I'd never had a horse blood tested in my life. I'm only now starting to educate myself about reading the results of them.
 
I had to ask for them specifically for my PSSM horse when she was 'off' earlier this year. Your vets will have the blood panel on record so you can ask to see it and see what they did test for.

My horse's enzymes were elevated out of work. The vet's comment at the time was that they were the results she would expect from a racehorse that had run the day before, not something that had been on the horsewalker for 45 mins.
 
So it's not PSSM 1

I got the test results back this morning n/n

The horse is still feeling sorry for himself but no longer sore in left lumbar or right shoulder so we're back on the rehab plan for now and making plans for getting to the vets
 
a little update - bad news but not terrible news!

I took the horse down to the vets on Sunday and left him there for a bone scan which was completed yesterday.

Some of the results are not overly surprising some are totally unexpected!

So he has bony changes in both hocks, both sides of the SI joint, withers, neck, fetlocks

SI was expected
Hocks not expected but not overly surprising
fetlocks, neck and withers? absolutely no idea what when or why - has anyone come across bony changes in these areas?

The other surprising thing after spending £££ on xrays, cartrophen injections, physio doing lots of rehab work is that there is no evidence of the lumbar KS that the other vet diagnosed - or any other spinal issues - confused on that one!
 
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Wheels said:
a little update - bad news but not terrible news!

I took the horse down to the vets on Sunday and left him there for a bone scan which was completed yesterday.

Some of the results are not overly surprising some are totally unexpected!

So he has bony changes in both hocks, both sides of the SI joint, withers, neck, fetlocks

SI was expected
Hocks not expected but not overly surprising
fetlocks, neck and withers? absolutely no idea what when or why - has anyone come across bony changes in these areas?

The other surprising thing after spending £££ on xrays, cartrophen injections, physio doing lots of rehab work is that there is no evidence of the lumbar KS that the other vet diagnosed - or any other spinal issues - confused on that one!
Click to expand...

Well done for keeping going with the diagnostics, at least you have something concrete to work on now, what are they planning treatment wise? Are they pretty positive about it?
 
they are going to take some xrays tomorrow - of the withers and fetlocks and maybe the neck as he wants to see if there are any bone chips or anything that might be causing those problems and then we will discuss treatments.

He did mention steroid injections but that he probably can't medicate all of the issues at the same time because there's a limit to how much he would use on one horse in one go. He doesn't think I will need to retire the horse but I don't know if morally it would be right to ride him again really with so many different issues going on. I need to do some research and some thinking about a way forward once I've got all of the results and info from the vet.
 
Well done for listening to him at least. I think a good long talk with the treating vet is the next stop as to whether any bits are better targets for treatment than others etc.
 
He was talking about medicating the most severe issues first which would be hocks, SI and withers in that order

but like I say I need to do some research - I know arthritic changes can't be reversed but I need to know if the rate of degeneration can be slowed down and the best way to keep pain to a minimum. I know that exercise can help to ease stiffness but does exercise speed up the rate of degeneration and pain become more severe in between exercise - if he gets steroid injections I know this will help with the inflammation but will it mean he feels he can gallop about and play more and therefore cause more damage over a shorter period of time or would he just be better on bute on the bad days and medication free on the others - are there any joint supplements that can actually do something to help

I realise these are questions for the vet but if anyone has any advice I'd be happy to hear it
 
The KS may well have resolved as a result of the work you did .
It's a very difficult situation .
I don't want to be unkind and upset you and I know how upsetting these situations are .
But what I think is vets like to treat it's what their trained to do managing all if this will cost £££££ and I would think very carefully about what you do now .
You can of course keep throwing everything at it but to what end will it be .
What do you want the horse for ?
It's one thing to treat an older horse whose performance has reached a certain level but a younger one not yet established is to me another thing .
Just because you can jab this that and the other and treat xyz doesn't mean you ought .
There's no right and wrong answers here .
Very difficult stuff .
 
Yes I'm having a battle with myself - I've owned this horse since a foal, he is now 7. It's heartbreaking even thinking about retiring such a young horse. Of course i had dreams of competing and going up the levels in dresage, he's got beautiful movement and an even more beautiful temperament. Dreams are smashed anyway as even if I do ride again I will never want to push him anywhere remotely close to his physical limit and riding at prelim and novice forever more is not appealing.

I can't see that a lot of travelling would be good for him either.

So that leaves low level schooling at home and hacking in the summer and probably not much in the winter.

And if I don't ride - he's currently not 100% comfortable in the field so he will need some form of medication even for that although that might not need to be permanent

Very difficult and yes, I know the vet is going to offer all sorts of expensive treatments which I will probably try once and monitor the horse to see how quickly they wear off.
 
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