Tests clear - what next?

Caramac71

Caramac71

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I posted on here recently about my daughter's horse. She's 6 years old, came to us a year ago having done very little. Always been a bit tail swishy but actually we think a huge part of that is mental attitude. Struggled getting into canter at first (usually a buck or a kick on the transition) but once in canter seemed fine. Did a whole summer of pony club stuff, including camp, and by the end of the year had exceeded everyone's expectations.

Turned away for 6 weeks over winter to let her chill out a bit. Came back into work in February with a much improved attitude. In April, having thought we'd mastered canter and was getting nice transitions, she started kicking out with her left hind - not on the transition but once in canter. This got progressively worse (previously when she used to kick out or buck on the transition it was only when doing flatwork - if you gave her a pole or a jump she picked up canter fine by herself).

Trainer noticed that she is going crooked in canter, twisting herself into an odd position and then kicking out because she's uncomfortable. Leg yielding her in canter to straighten her out helped. But then she started anticipating the canter and becoming reluctant to work.

Have had saddler out, then a second opinion from a different fitter. Have tried a different girth. Had physio, who found her very tense on her left side and felt she was trying to protect something, so (having been speaking to the vet throughout) we got the vet last week.

Vet couldn't see any lameness but agreed she was in pain. He felt the issue was in her back so we went into clinic with her yesterday. Saw the orthopaedic vet, ran through all the same tests, couldn't detect any lameness issues. Xrayed her spine (I think we were all expecting to find some degree of kissing spine) but that was all clear. Blocks to SI joints and suspensories made no difference.

They've kept our horse in overnight to starve her and scope this morning for ulcers. If that comes back clear, the vet says the next stage would be to bone scan (in a few weeks).

However, I have a concern that the insurers wont pay out and I've already run up a bill of £1000 (which is over and above my emergency fund!). Realistically I'm not in a financial position to fund a bone scan (vet has quoted £1800) especially as nothing so far has given any indication of the problem.

I think my plan would have to be to turn her away for a bit, pay off this vet bill, save up some money and see whether there is still a problem in a few months time.

But meanwhile, is there anything we are missing trying? I did ask the vet about whether it is hormonal behaviour - she thinks not as the problem is worsening and she would expect to see changes for the better/worse during her cycle. She is in season for 10 days out of every 20, which I know isn't usual but seems to be normal for her. Last year, other than her first 2 seasons when she arrived, we didn't really notice beyond that when she was in season.

In addition to the kicking out in canter (which has now progressed to refusing to canter, to then being reluctant to trot, possibly because she is then anticipating canter), she is very girthy, she is sensitive to grooming on belly/flanks, she walks away when you approach with her saddle, she tenses up on leg aids and will actually go forward better if leg is taken off. She is becoming nappy but I believe (as does everyone that has seen her) that her behaviour is a result of some underlying pain as opposed to "just" behavioural.
 
Surely if she is having unusual cycles the vet needs to investigate that as the cause of back pain, certainly before an expensive bone scan when most of the tests so far have failed to find anything, I have very little experience of mares and their reproductive systems but to me this is a case where the mare is not "normal" so would be the first place to investigate, not the last.
A course of regumate may be all she requires to get her cycling more normally, they can get cysts, which can cause all sorts of issues as well as many other problems relating to their seasons, a vet experienced with reproduction may be the best to ask for advice.
 
I wouldn't be going down the bone scan route at this stage. Her symptoms suggest ulcers/ovaries to me, possibly both by now as ulcers are often a response to pain. I am afraid that some vets hear the word "insurance" and do far more than is strictly necessary.
 
be positive said:
Surely if she is having unusual cycles the vet needs to investigate that as the cause of back pain, certainly before an expensive bone scan when most of the tests so far have failed to find anything, I have very little experience of mares and their reproductive systems but to me this is a case where the mare is not "normal" so would be the first place to investigate, not the last.
A course of regumate may be all she requires to get her cycling more normally, they can get cysts, which can cause all sorts of issues as well as many other problems relating to their seasons, a vet experienced with reproduction may be the best to ask for advice.
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Thank you, I was wondering whether to ask the vet for an ovary scan and/or regumate trial to see if that made any difference. I feel really out of my depth making suggestions, I'm a first time owner with no experience of anything like this. Vet is ortho specialist and I had to push to get the scope done as she is obviously looking at things through an orthopaedic view.
 
Pearlsasinger said:
I wouldn't be going down the bone scan route at this stage. Her symptoms suggest ulcers/ovaries to me, possibly both by now as ulcers are often a response to pain. I am afraid that some vets hear the word "insurance" and do far more than is strictly necessary.
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Vet is aware of my concerns about insurance and I have requested all along that we keep everything to a minimum in case they wont pay. She has said that the insurance may now class this as behavioural if we don't find a cause, so would need to do a bute trial first. The plan is to put through the claim so far and see what they say. At least I will know financially what position I am in.
 
Caramac71 said:
Thank you, I was wondering whether to ask the vet for an ovary scan and/or regumate trial to see if that made any difference. I feel really out of my depth making suggestions, I'm a first time owner with no experience of anything like this. Vet is ortho specialist and I had to push to get the scope done as she is obviously looking at things through an orthopaedic view.
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I think you need to push, nothing has been found to suggest lameness, ulcers are a possibility but the ovaries seem the obvious place to start, as this has been going on for some time you may well find you have problems claiming on the insurance so be very careful as the vets will continue looking once they start and if nothing is found you could end up with a hefty bill and no diagnosis.
 
Does she improve or get worse within a ridden session? Have you tried having an experienced small adult ride her to assess her? What about on the lunge / long reins without saddle, does the behaviour continue? When she was out of work how long did it take for the behaviour to restart/get worse after she came back into work? What's her management routine, is she stabled etc. is she better or worse after turnout or no different?
 
Ifs she's been scanned for ulcers get them to go the other end as well and get her ovaries scanned whilst she's still sedated.
 
(Sorry I'm a bit rubbish with the quoting so I've just answered questions below!)

Does she improve or get worse within a ridden session?

Worse. Up til physio came (things changed again after that) she would walk and trot really well. It was only once she had been asked to canter once that the behaviour would start. One PC instructor deemed her to be "naughty" and got my daughter to keep riding through it throughout the session. Kicking out got worse and worse, until she started napping and not wanting to go into canter. Since last physio session she has flat out refused to canter on either rein - however this coincides with diet change as we had been feeding low sugar/low starch and thought it hadn't had effect so at the same time as physio coming, we had gradually returned to usual diet.

Have you tried having an experienced small adult ride her to assess her?

Usual trainer (weekly lessons) is convinced the problem is pain related - she has got on her and confirmed what she could see is the same as what she can feel. The plan had been for trainer to school weekly while my daughter does her GCSEs but we decided we needed to eliminate pain first.

What about on the lunge / long reins without saddle, does the behaviour continue?

Originally fine on the lunge (better without saddle). Now reluctant to canter even on the lunge, and when she does it tends to be rushed and a bit wild whereas previously she lunged really well in all paces. Same reaction to lunge roller as to saddle girth (in case this is relevant).

When she was out of work how long did it take for the behaviour to restart/get worse after she came back into work?

Brought back into work mid January. Gradually built up (ie hacking to start and then light work in school, then including some small jumps, etc). Had one episode of unusual behaviour end of March which we think coincided with her first season (a few days before the squirting/flirting started). Kicking out started 7th April and gradually progressed from there.

What's her management routine, is she stabled etc. is she better or worse after turnout or no different?

Lives out 24/7. I have concerns that she wasn't getting sufficient hay over winter (dropped lots of weight, having come to us bordering on obese - previous owner never had any problem with keeping weight on, in fact quite the opposite). Which is why, although she lives out, I am concerned about ulcers.
 
I agree that it would be worth scanning the ovaries.

With regards to your insurance - I would contact them and ask what they will or won't - if anything - cover.

I always do this before embarking on costly proceedures, your Vet may need to email them their report and bills so far.

Hope you find out the cause :)
 
I've already phoned and asked, and they said they couldn't see anything on the policy to exclude anything, so she's covered for vet bills up to £4k. My problem is that they've never seen her vet report and because the vet noted some things that he deemed "behavioural" at the time, once they see the vet report (which claim form asks for so I cant get out of providing) they may say this is pre existing. So until I put in a claim I wont know what their take is on it. The problem is, the behaviours that she displayed at the time of vetting were very much down to her being young, green, spooky and stressed and over the course of last year she settled down and was great. The new behaviour is very recent and different but I'm not sure the insurance will take that into consideration.
 
I saw on FB your post re the tests. It does sound like ovaries and possibly ulcers on top. I've been trying to remember who it was that had ovary issues with their mare so I could give you their name to talk to, but I'm struggling to remember.

I would get an interim claim in with the insurer (who is it, out of interest?) as then you get an idea where you stand. And, if needed, you can get it moved forward to being a complaint if they turn the claim down and shouldn't have.

Get M to come up and have a play on Hec when her exams are out the way, we're stabled right by M & Rod so they could meet up to ride.
 
jc78 said:
I saw on FB your post re the tests. It does sound like ovaries and possibly ulcers on top. I've been trying to remember who it was that had ovary issues with their mare so I could give you their name to talk to, but I'm struggling to remember.

I would get an interim claim in with the insurer (who is it, out of interest?) as then you get an idea where you stand. And, if needed, you can get it moved forward to being a complaint if they turn the claim down and shouldn't have.

Get M to come up and have a play on Hec when her exams are out the way, we're stabled right by M & Rod so they could meet up to ride.
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Thank you. It's Scottish Equestrian (SEIS) - they were lovely on the phone but we'll see what happens when the claim goes in.

Thank you for the offer, I think she will take up all riding opportunities as she's got a long summer ahead and was looking forward to all the fun things they could do.
 
Surely if your vet can certify that the horse is in pain, the insurance will pay out? If they claim the behaviour was pre-existing and therefore the condition, your instructor will be able to provide evidence to the contrary. I wouldn't worry too much.

The condition worsening when you changed the diet suggests ulcers to me or maybe ovaries so hopefully the investigations they do today will mean the bone scan isn't necessary.
 
The first thing I would do is change the diet back to the one that her behaviour was better, or less bad, on. I don't really understand why you changed it back to the previous feed. IMO no horse can benefit from high sugar/high starch, unless in very exceptional circumstances and prescribed by a well-qualified vet.
I would be concerned that your specialist vet doesn't look at the broader picture, several non-specialists on this forum have suggested ovaries/ulcers just from your description of the symptoms. Perhaps you could ask for a 2nd opinion.
As for the insurance company, they are the best people to tell you what they will pay for, I'm not sure why you are panicking at this stage, it sounds as if you still have £3k in hand, unless I have misunderstood your posts.
 
I would change her diet back as well. I would also push for ovaries and ulcers to be checked for urgently. It sounds like pain but not really limb or back pain if that makes sense. Sounds like something inside, poor thing and I am not overly taken with what the vet is saying. On what grounds is he suggesting a bone scan. It sounds rather odd that she isn't lame, nothing has been found with other tests yet that's his next suggestion.
 
annagain said:
Surely if your vet can certify that the horse is in pain, the insurance will pay out? If they claim the behaviour was pre-existing and therefore the condition, your instructor will be able to provide evidence to the contrary. I wouldn't worry too much.

The condition worsening when you changed the diet suggests ulcers to me or maybe ovaries so hopefully the investigations they do today will mean the bone scan isn't necessary.
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I think the main issue is if nothing is found on the bone scan it will be down as behavioural and then they won't pay out.
 
ester said:
I think the main issue is if nothing is found on the bone scan it will be down as behavioural and then they won't pay out.
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Oh right, I thought the concern was they would say it was pre-existing because the vetting report mentioned behavioural issues (albeit different ones).

Genuine question here as I've never seen a bone scan, but does it literally just show up bone related problems or is it all pain, so soft tissue as well? Just wondering if it rules out all pain or just bone problems?
 
ester said:
I think the main issue is if nothing is found on the bone scan it will be down as behavioural and then they won't pay out.
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If that happened and this were my horse, I'd be very cross! The only reason that nothing would show on a bone scan is that there is nothing wrong with the bone and so far there is nothing in the previous tests to indicate that there might be. I would certainly be pushing for different tests.
 
That might be the case too, am not sure possibly not as OP has said behaviour has got much worse/changed since then.

I think it just shows up hot spots in bones. you need MRI for soft tissues.
 
Pearlsasinger said:
If that happened and this were my horse, I'd be very cross! The only reason that nothing would show on a bone scan is that there is nothing wrong with the bone and so far there is nothing in the previous tests to indicate that there might be. I would certainly be pushing for different tests.
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I think for that reason vets do usually find something though ;).
 
Pearlsasinger said:
The first thing I would do is change the diet back to the one that her behaviour was better, or less bad, on. I don't really understand why you changed it back to the previous feed. IMO no horse can benefit from high sugar/high starch, unless in very exceptional circumstances and prescribed by a well-qualified vet.
I would be concerned that your specialist vet doesn't look at the broader picture, several non-specialists on this forum have suggested ovaries/ulcers just from your description of the symptoms. Perhaps you could ask for a 2nd opinion.
As for the insurance company, they are the best people to tell you what they will pay for, I'm not sure why you are panicking at this stage, it sounds as if you still have £3k in hand, unless I have misunderstood your posts.
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Sorry, I've probably not been terribly clear (head is in a bit of a mess!).

She has always been fed in the field (she's on full grass livery) - fed on pony nuts with a handful of chaff twice a day. Over winter we started giving Baileys Keep Calm as an extra feed to help with her weight without giving more energy. When the behaviour started, I spoke to Baileys who suggested that the Keep Calm was very low sugar/low starch and to try feeding exclusively that (mixed with chaff to make her chew). Because it's bulked out with water it is quite a large feed even at the minimum quantity for her of 2.2kg per day so I was splitting it over 3 feeds. Because the horses are all field fed at the same time, I was having to go down to the yard at each feed time (7.30am and 3pm) to bring her in and feed her separately. We did this for a month (also giving a trial of equishure) and found no difference, so we gradually returned to her normal feed of nuts/chaff.

Vet has scoped for ulcers today and no problems there. We discussed hind gut, tests, supplements, feed etc. but she thinks the likelihood is low and her management looks good.

The repro vet is in today so she's going to take a look at her later and scan ovaries, to rule that out. Possibly even go for a regumate trial over the next few weeks while we see what insurance says.

I think maybe I've allowed myself to get panicked by other people's reactions to the insurance, telling me they will use whatever they can to get out of paying and to prepare myself to not be covered. But I didn't want to go agreeing to every test under the sun and then find myself with a bill that I just cannot pay. Really, until we put the claim in, I just dont know but I have at least prepared myself for the worst.
 
I am so grateful for all your replies. As above, scope has been done and found nothing. Ovaries are being scanned this afternoon and possibly a regumate trial after that. If we go the bone scan route there is nothing we can do for a few weeks anyway so makes sense to rule out as much as possible.

I've had a chat with the vet on the phone. She is a lameness expert so that is what she is looking at, and she thinks it is most likely sacroiliac disease. A bone scan would confirm this, or may find something in the back that hasn't been picked up on xrays.

If insurance refuse to pay for the bone scan, then she would suggest treatment for SI disease (steroid injection then programme of lunging etc before returning to ridden work).

My insurance concerns are now twofold - the initial worry was that what was written on the vet report might be deemed as pre existing as the horse had bucked on transition into canter, was tail swishing when ridden and was sensitive to back palpation (although had reasonable range of movement), although vet had also noted that she was green, spooky, and a whole host of other things that attributed to her being a young horse. Canter work improved massively with the aid of poles and hacking, tail swishing seems to be a bit of a mental thing with her when she's under pressure, and once we had a correctly fitted saddle and a physio massage (and I've kept up regular checks with both due to the fact that she is still growing and changing shape) the back didn't appear to be an issue. But although I can explain all that, and have dressage tests and hundreds of videos to support it, I've been told that insurance will just see the black and white.

But now, without a diagnosis, I understand the insurance can also deem it to be behavioural in which case they wont pay.
 
I know you've talked to them already but I'd speak to them again. Tell them your concerns and see how they respond.

A good while ago my horse was lame. X-rays showed nothing. Vet gave me 2 options to assume it was soft tissue and treat accordingly or go for MRI and know exactly what we were dealing with. Treatment would be roughly the same with minor tweaks depending on exactly what the injury was and its extent. He told me to check with insurance as some didn't cover MRI. I spoke to them and they told me it was up to me whether to do it or not, they would pay for it but it would obviously add to the claim and my limit was £3k so wouldn't leave much room for treatment. I opted not to do the MRI as apart from anything, the nearest scanner was 5 hours away and I didn't want to take a lame horse on a 10 hour round trip(these days there's one 1/2 an hour away!) You might find they say the same - it's up to you (within reason) how you spend up to the limit, but be aware the limit is there. Not all insurance companies are bad. Mine paid out every time I made a claim. Excluded plenty afterwards :rolleyes: but they did pay out.
 
Thanks for the explanation of your feed regime, OP.
Having had a mare with what appeared to be behavioural problems (because it wasn't anything else discoverable) which eventually was found to be food related, I would take your mare off all except grass-based feed. I would replace your pony nuts with grassnuts and feed them soaked with dried grass chaff, e.g. Graze-On/Just Grass.
My mare appeared to have all kinds of problems/symptoms including ridden discomfort and a cough, which all cleared up as if magically when her diet was adjusted to remove every trace of refined sugar/starch.
 
Pearlsasinger said:
Thanks for the explanation of your feed regime, OP.
Having had a mare with what appeared to be behavioural problems (because it wasn't anything else discoverable) which eventually was found to be food related, I would take your mare off all except grass-based feed. I would replace your pony nuts with grassnuts and feed them soaked with dried grass chaff, e.g. Graze-On/Just Grass.
My mare appeared to have all kinds of problems/symptoms including ridden discomfort and a cough, which all cleared up as if magically when her diet was adjusted to remove every trace of refined sugar/starch.
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Thank you, I'm so open to anything and it's really helpful to know what works for others. I won't change anything until we've done the regumate trial, just so we can clearly rule out what doesn't work, one thing at a time.

Did your mare always have problems? I can't help wonder if it's significant that ours has started in Spring, either related to her seasons or to the sugar changes in the grass. Because there was nothing more difficult being introduced into her workload that we believe could have changed her behaviour.
 
Sorry to see your problems OP. Just to say that reading your opening post my first thought was 'ovaries' and I really hope you are able to get to the bottom of the problem.

You might find it of interest / help to search on here for references to ovaries - I am sure I have read of mystery issues in others' mares which turned out to be explained by ovarian problems.
 
Caramac71 said:
Thank you, I'm so open to anything and it's really helpful to know what works for others. I won't change anything until we've done the regumate trial, just so we can clearly rule out what doesn't work, one thing at a time.

Did your mare always have problems? I can't help wonder if it's significant that ours has started in Spring, either related to her seasons or to the sugar changes in the grass. Because there was nothing more difficult being introduced into her workload that we believe could have changed her behaviour.
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I agree, one thing at a time.

We realised, far too late, that her problems stemmed from a period before we got her, aged rising 4. She had been kept very short of food as a 2 yr old and then, having been bought back by the breeder, was fed up over too short a time. As a 4 yr old, she seemed to be normally green, rather spooky and sensitive. She was difficult to deal with because she was proud of her food and when we got her over that, she remained 'girthy' and difficult to rug. We always had to be aware of her teeth.
It is many years ago and the only feeds available at the time were coarse mixes and straights. After we changed her diet, it took a lot of searching to source alfalfa cobs which were imported from Canada. And tbf, I have found out a great deal more about appropriate diets for horses in the intervening years. It is great to see that nowadays, it is recognised by most people that the best diet for horses is a hi-fibre one.
 
Spanny said:
Hi OP, any news on the ovary scan yet? Keeping everything crossed that you get a diagnosis soon.
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Absolutely perfect - showed she is in season, which we knew she should be, but nothing other than that.

I guess somewhere along the line I should take comfort in the fact that everything appears to be in tip top condition - but vet (and physio and trainer) are all as sure as we are that she has pain somewhere, so we really need to find out what and where before we can continue.

We've gone home with a months supply of regumate - to rule out anything hormonal as the behaviour did coincide with the start of her first season this year. We don't think it is related, as there is no variance to her discomfort throughout her cycle, but anything is worth a try.
 
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