Rehab- am I expecting too much?

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chaps89

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Will try to keep this short but apologies in advance!
Bought a 14.2hh 5 year old mare a year ago, broken but only ever been a light hack and effectively bought from the field. Slowly bought her into work and start of July went lame. X-rays showed ringbone in all 4 feet, vet suggested turn away for 8 weeks. Bought back in and was lamer than before- vet advised should be the same or better. Sent to liphook for full work-up including full body bone scan which was clear. Narrowed down to check and suspensory ligament damage in near fore. Box rested/restricted turnout from november - Jan with 10 mins walking/day. Since Jan have increased t/o so is out for a full day in the area the size of half a menage. Work been slowly increased too- until march was doing 30 mins walking 6 days per week. As of march under vet instruction have slowly upped to an hour/ day and introduced schooling. Now does 2 hacks per week that are about an hour/just over, 2 short hacks of 20-30 minutes and 1 or 2 schooling sessions that are as long as they need to be. We do some trot in each ride but I pick surface/ take gradient into account. It's worth noting we are in a VERY hilly area. In April went lame(r), nerve blocked to the near fore foot, x-rays showed minimal change to ringbone. Also has ems and physio has found tightness over her sacroilliac/lumbar area which is improving with correct schooling and stretches/exercises. Dramatic improvement following shoeing although no change made to shoeing, however now 4 weeks into shoeing cycle starting to seem 'off' again so vets suggest mri. However this aside, she is still really struggling to do rides longer than 40/50 minutes, feels very tired by the end. Vet tested for muscle enzymes which were about 50 above what they should be so very very minimally increased and not of concern to the vet.
My question is, nearly 6 months into being bought into work, should she still be feeling so tired on longer hacks, falling out/unable to maintain a straight line on her own? She has obviously got quite a list of health problems but interested in others experiences in rehab and what stage you've been at 6 months in. My poor vet is probably sick of me and my bank balance is much depleted and I'm not seeing the wood for the trees anymore! She is well in herself and has a real 'give it a go' attitude (tho is very much a fiesty cob mare!) and please, no criticism of riding such horse- schooling has been under supervision/instruction of bhs i/listed dressage judge and on vet advice. Horse is usually only 1/10th lame at worst and most people say she's sound, worsening to 3/10ths lame when she got worse in April.
 
No suggestions to add but its a sad situation to be in with such a young horse. Kind thoughts coming your way..
 
I don't know what to think, almost any horse should be able to do what you are asking. Have you had physio back out, or thought about acupuncture, not something I know about, but worth looking into, I think.
I assume saddle fits well and she is not obviously sore anywhere. Is the conformation normal and the wind sound.
The shoeing must almost certainly be of significance, are the feet good, is the pastern slope OK, heels balanced. Is there a really experienced farrier you can ask, or is your own experienced with remedial stuff, we have a variety of farriers here, some are good, some are not so good, and one does vet farriery for the vet school, and although I did not like the way he shod my horse [new balance], he would still be my go-to if I had this problem.
 
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Are further bloods test an option, is it the ems, to be honest I would be considering trying to find a research project where she could be used for research, I know this is a long shot, but you don't know unless you ask.
 
A few thoughts that come to mind, firstly she has never been fit as in properly hunting or even decent hacking fit so you have no base fitness there, I find youngsters with no issues can take a couple of years to establish a good base level from being initially started to being able to miss some work without going backwards, if that makes sense.

So I would think of her as a recently broken 4 year old then take into account her numerous issues and period of box rest/ restricted turn out and decide whether she is still feeling weaker than she should, I expect you may then feel less depressed!

She is still on a very limited turn out area so getting very little movement apart from when you ride, she will barely be able to get going in a straight line and certainly not at any speed, obviously good for preventing any further injury but less good for helping her find her own balance or get any fitter while she is out, can she either have a bigger area or could you set up a track so she moves more but is still restricted, that may really help her.

I think that if you consider how little she has really done you should be reasonably happy with what she is now doing, don't forget she is still not 100% sound, has ringbone which is not going to be totally comfortable and possibly starts to niggle after a while on exercise plus the ems means you are probably giving her a low energy and restricted diet, not really surprising she runs out of steam, I would expect her to take another 6 months to get to a reasonable level of fitness on the regime she is on and try not to be too deflated it seems as if you are making progress even if at times you do not feel like it.
 
Also agree with "be positive". Also may pay to do additional blood tests to see if anything developing/trends over time.
However, consider too that at 6 she may still be growing/developing (even if not height-wise, she could be using energy for laying down more bone etc.) and there is commonly a growth spurt in spring so she may be using energy for this too. And even if not growing, she will still be using energy for tissue healing. So, may pay to double check with your vet/s that she is getting the right kind of nutrition for work plus maintenance plus healing (i.e. not just enough calories, but the right content and quality of protein etc too).
This all becomes even more crucial due to the EMS too; if you think of EMS as being something like 'diabetes for ponies' then it is easier to see how getting the nutrition wrong can have a large effect on energy levels for different things.

Another thing that you may not want to consider but may be essential at some stage is whether this pony has a long-term future; sometimes multiple medical conditions can break your heart as well as your bank balance. In reality, there is only so much you can do to keep a horse pain-free if these conditions become chronic. However, your pony is very lucky to have come across you as an owner and it is obvious that you are doing everything possible for it.
Best wishes
 
Thanks all - and also apologies, thought I'd posted it in vets. Am going to do a general reply and hope to encompass all comments - all replies have been read and appreciated, thank-you.

Saddle checked and adjusted as necessary- done in March then again last week so definitely on top of that!

She is shod in natural balance shoes ever 5 weeks by an experienced remedial farrier, following x-rays done in October 2014 and again in April 2015, her feet are looking good in regards to heel first landing, heel support and general foot balance.

Conformation is reasonable, nothing glaringly awful.

EMS - we haven't actually tested for but she has all the symptoms and is on 22 metformin daily at moment and when we take her off it symptoms worsen. Over summer last year despite being muzzled and on a track system she went up to a stonking 502kg. I have now with work, no rugs all winter and restricted food got her down to 445kg. She has lost a further 10kg according to my weight tape too.

Feed wise she gets a handful (and I mean a handful - not even half a scoop for 4 meals) of hi-fi molasses free, and a quarter of a cup of top-spec lite balancer per meal (could potentially up this?). She gets equine America 'buteless' glucosamine supplement (showed no difference on a devils claw sup, am sceptical that this is working either) and that's it.
Tried her on forage plus balancer but she wouldn't eat it - and this is the horse that will eat normal bute and metformin from your hand!
She gets 4kg of soaked hay morning and night. Soaked for anything between 1hr and overnight (I work shifts and have assisted DIY but YO doesn't charge me for assistance so I don't like to take advantage) Her pen is completely bare so grass intake really is minimal.
She is *hungry* on this amount of food and so will get a pad of dry hay in a hay net when she comes in (more co-operative to ride/handle if she gets it!)
Is there a metabolic friendly energy feed or anything more suitable that I could do with her diet at all?

She is a forwards going, whizzy type, definitely not a plod along, kick along type (hence reluctant to give anything too energy providing!). Which is how I know she's tired/struggling - she sets off in a good walk, comes back and it's like she's dragging herself through treacle.

Completely agree with more space helping her case (I ride a welshie who lives out in a big hilly field and he comfortably hacks out for an hour once a week no problems which I put down to his turnout)
Unfortunately at my last yard she had a track around 1acre field and it was perfect (tho she managed to balloon on it as it was) but the other grass liveries left and so she took to jumping out over 5ft fences so we had to move.
Grazing wise - I would like to increase her space however there is just too much grass in any other field and I need to double the fencing by putting small posts on top of big posts to make it big enough she won't jump out which is a cost I would struggle with at the moment tbh. That said, the field she has her pen in is small anyway (jumping arena sized) but potentially I may be able to run a track around it and so will discuss with YO.

She definitely has grown, both upwards and in terms of bulking out since I bought her and it is of course possible she is still going though she's seemed stable in size for the last 6 months or so.

That is a very good point about her never having been fit previously and therefore very encouraging as I hadn't really taken that into account, thankyou.

It is unfortunate as she was bought as a project pony to sell on to make a bit of capital to be able to afford a horse for me after losing my 'horse of a lifetime', 3 failed vettings and an unsuitable one that was lwvtb that had to go back! (So if anyone has a cheap, easy to run, nice to be around horse they wish to loan out please feel free to let me know ;) )

It is very much a consideration how much more to put into her - my vet describes her as 'not for the novice or faint-hearted'! She is very much an adults pony not kids and to handle needs ruling with an iron fist as she will test the boundaries daily (never known a horse like it!) That said to ride she is a pleasure and in the school she is starting to offer an outline, and starting to comply with lateral work and has a genuine 'I'll give it a try' attitude to her work as well as being a lot of fun.

In an ideal world I would like to get her sound enough to find a competent sharer who can cover the extra costs and give me some of my life back (I bought her as I need a horse that can live out, barefoot and live on fresh air. She is stabled part-time, has shoes all round and due to such limited grazing will get hay all year round. Over summer my YO has agreed she can go out 24/7 which has started this weekend and back shoes will come off in autumn if she's still here (don't want to do it whilst ground is so hard) to see how we go but I am struggling with the additional expense now) Due to her various problems I won't sell her and can't expect anyone to take her on loan really (we are still a way off that anyway)

To give insight as to the extent of her problems - when her feet were x-rayed, the vet said she had the legs of a 15 year old competition horse who'd had a hard life, and liphook want to do a neurectomy on the near fore as essentially the suspensory has disintegrated by the cartilage by the knee.
This said, she is full of beans, bright in herself and minimally lame and so most of my yard cannot see/do not understand her health problems and think I am awful for having to keep PTS as a potentially real option in the back of my mind.

I am awaiting a call back from liphook today as based on last month we expected her to go substantially lamer mid-way through the shoeing cycle but she hasn't and so I don't know if they will still suggest mri or not and also to check that they are happy with current workload, when I can expect to introduce canter (I can hope right!) and increasing her turnout.

Once again, massive apologies for the sheer length of this post!
 
You are definitely not awful for having to think of PTS as an option! The problem with shared yards is that there are a lot of people that anthropomorphise horse situations and don't put the welfare of the horse first. Believe me, I have worked in vet clinics for years and seen people keep animals going because they 'love' them whereas if the same animal had been found abandoned the public would be up in arms about animal cruelty!
You also have to be practical about the financial situation and if the people at your yard would like to fund the ongoing treatment of your pony then you could ask them for donations (I suggest a minimum of £100 per person as a starter, and warn them that the costs will be ongoing). There is also the issue that some horses can have a lot of damage before showing much in the way of outwards signs of pain (this is an evolutionary thing because they are a prey species and need to hide it from the predators) - but this does not mean that they are not in pain.

I would be guided by what Liphook says, as a neurectomy is often a 'last-resort' measure, with significant side-effects, so the damage might not heal itself. In an ideal world there would be a cure for everything, but some things cannot be cured, but Liphook will let you know of the likely outcomes of her various conditions. You could also ask them about nutrition in the meantime.
Good luck.
 
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Thanks for your reply. Completely agree - I am very much of the 'week too soon than a day too late' camp.
It's a shame as she could potentially make some-one a very nice/classy happy hack but the type of person able to stay on top of her behaviour/manners is unlikely to be the same person as one who wants a pony with physical limitations making them a light hacker.
Hehe - maybe I need one of those facebook posts - 'help, I can't afford my poorly pony who isn't suitable for any job whether that be broodmare (why would you given her physical problems), companion (has to have restricted grazing and won't stay in the field on her own) or ridden (broken) so please give me money before I have to have her pts!' (I jest of course!)

I wouldn't have the neurectomy - 1) we have maxed out the ligament claim and I certainly couldn't afford it and 2) I am not convinced by the procedure being a good idea anyway. Interesting though as the vet said she couldn't count the number done on hind limbs but could count on one hand the number of fore-limb neurectomys she's done.
 
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Gratuitous photo- the one at the show is just a week before she went lame, we did the novice showing class at the local rc show. She is now hairy/au-natural after she made her feelings about clippers/pulling clear and left my foot very badly bruised when I tried to maintain the hair-free do! Other photo is about 2 weeks ago. Apologies if they're huge, bit hard to tell on my phone.
 
Can't seem to edit posts on my phone. If anyone has any comments on her conformation would be happy to hear them.
Spoken to liphook this morning, vet has essentially echoed what be positive said- to give her time, she's probably about where we would expect her to be given her age and how much time off she had.
She thinks workload is fine, can gradually increase the trot and depending how that goes add tiny bits of canter in a month or so's time. There isn't any rush from my perspective, I just needed a bit of re-assurance that we were going in the right direction. Feed wise she suggested adding a bit of veg oil and has ok'd an increase in turnout area. All on the basis of ongoing monitoring and that we still have 11 months left on the new lameness from last month on the insurance should we need to do anymore investigations. Thanks for the helpful replies all.
 
She's a nice looking horse and best of luck with her - she's very lucky to have you.

I am in no way expert but I wonder about adding some oats to her feed? That would give her some energy and I think they are also high in protein. However this may be an extremely bad idea so please don't do it without asking somebody who knows what they're on about.
 
Lovely photos
Personal opinion only!
A very nice type with good slope to the shoulder. Compact short back and good angulation in the hindquarters. Looks as if she might grow another 1/2" or so.
Tending to be a bit straight in the hindleg and short in the pasterns, but this looks more so in the second (hairy) photo than the first (whereas the shoulder looks better in the second); and my preference (and ‘eye for a horse’) is towards Thoroughbreds, so this is in comparison to the type of conformation I am used to. Maybe a bit short in the length of rein and I prefer a TB type-shape of the head, but she has a kind eye and ‘honest’ expression.
I can certainly not see anything about the conformation that would put me off buying her if I was looking for a horse to do what you want to. Maybe someone who is more familiar with her type could give some added input.
 
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Its hard to tell from your photo and particularly due to the feather, but the angle of her feet does look to be broken forward, - this can cause issues in the foot. I've added a link to a website that explains hoof angles, and implications. Hope this helps -

http://www.equipodiatry.com/hoofangl.htm

and a useful one on ringbone

http://www.thehorse.com/articles/26843/ringbone-in-horses

http://rockleyfarm.blogspot.co.uk/2012/08/hoof-pastern-angles-shoes-and-back-of.html

(GOSH I CAN STOP READING ABOUT HOOF ANGLES NOW - I PROMISE THATS THE LAST)
 
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Smurf's Gran said:
Its hard to tell from your photo and particularly due to the feather, but the angle of her feet does look to be broken forward, - this can cause issues in the foot. I've added a link to a website that explains hoof angles, and implications. Hope this helps -

http://www.equipodiatry.com/hoofangl.htm

and a useful one on ringbone

http://www.thehorse.com/articles/26843/ringbone-in-horses

http://rockleyfarm.blogspot.co.uk/2012/08/hoof-pastern-angles-shoes-and-back-of.html

(GOSH I CAN STOP READING ABOUT HOOF ANGLES NOW - I PROMISE THATS THE LAST)
Click to expand...

More - sorry

http://enlightenedequine.com/2012/05/15/hoof-angles-part-4/
 
To be perfectly honest if she was mine I would have it at the front of my mind. You've done an awful lot for her and the out look sounds bleak and expensive at best!!
 
Good luck with whatever you decide but I'm always doubly wary of horses that are 'from the field' as there is generally a reason for it - soundness or behaviour related issues. Sorry you had to learn the hard way, it sounds like you have done everything you can to get her right.
 
We have discussed barefoot at length and farrier is very pro barefoot for a lot of his clients but at the moment we are happy with shoes for her. I don't have any recent close-ups of her feet but x-rays were done a month ago and are good (other than the bony changes)
She's very much a compact horse all over, she takes a 16.5" saddle (not sure on rugs, she's only ever worn one once, lol) it's always a shock riding her after the very long 15.2 welshie I ride!
The lady I bought her from is as straight as they come (and well known in the local horse community for the right reasons), it's just been unfortunate she went lame soon after purchase but I'm sure it was a genuine sale and we know her full history too. However I can see why you might say otherwise.
 
If her hoof balance is not right, and from the pic the angles of her feet look broken forward, this is likely to cause you issues, if not possibly the cause of some of the problems.

X rays will only show bony damage done, they wont show any presence of discomfort in soft tissues. If you look at the first link I sent it explains various problems caused by poor foot balance, and a broken forward foot predisposes to suspensory problems, which she has had.

Up to you of course but foot balance is being recognised as a major issue in lameness - both bone and soft tissue, and it is something that we can do something about.
 
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