Where to look next…any advice welcome ?

Lammy

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Posting this to see if anyone out there has any good ideas of where to look and what to try next on a horse who has almost exhausted all the diagnostics on offer ?

I’ll timeline it to try and make it easy to read;

March 2021
Horse scoped after displaying signs of ulcers, girthy, difficult to tack up and bucking when the leg went on, even for walk to trot, couldn’t even get trot. Only did 3 rides before calling the vet. No ulcers but stomach inflammation, supplement from the vets showed improvement as quick as 3 days so he was put on it for a month.

April-May
Horse was better but not working like he had in Jan/Feb, found it difficult to work long and low and was not searching for the bit. Saddle checked and bit lady out both seemed to improve things for a week until things slowly started going in reverse (still on gut supplement).

Began tripping on the hind left leg in trot and canter, also lost ability to get correct canter lead on the right rein. Each ridden session got worse, right rein canter faded first from a lap of the school to half a circle to barely getting a stride. Couldn’t maintain canter, same then happened to the left rein canter.

June
Vet came out best one at the practice. No reaction to flexions, said he would pass a 5* bet on the ground/lunge. Then rode for the vet, said he looks like he’s going around with handbrake on. He’s trying but really can’t maintain the canter and the trot is a struggle. More shuffle than anything. Referred for bone scan.

Bone scan showed tiny tiny hot spots on neck and back and a slightly bigger one on left hock. X-rays of neck and back were clean as a whistle, best back X-rays I’ve ever seen on a horse! Hocks showed the start of osteoarthritis but first vet didn’t think this was significant enough.

Went back to the referring hospital for gait analysis and nerve blocking. All pointed towards hocks so injected with steroids and sent home with a plan.

July - Present
Started bringing horse back into work, was brilliant out hacking in walk (tripping stopped) but as soon as was asked for a trot got the same shuffly ears back trot as before deffo not happy. Same in the school and couldn’t even get canter. Back to vets.

Nerve blocked the suspensories 3 weeks ago and no response so they’re ruled out now at least. Referral vet thinks he is pretty much orthopaedicly clean. They want to scope but I’ve said I’m not sure on that since his scope was so recent and the symptoms are very different. They’ve sent us home on a bute trial which we are almost at a close of.

Horse is much better on a bute trial happy to walk trot and canter out hacking, due to try a canter in the school this week but his trotting is much better, still tense but I think this is more due to pain remembrance than anything else. He hasn’t tripped once now though since the hock injections so they’ve definitely done something. I rang my original vet and caught him up on everything and he said to him bute says orthopaedic not stomach, he was quite assured bute would make any kind of ulcers or inflammation worse.

The only thing is where do we look next??
Both vets agree it’s not lower down the leg, referral vet remarked last time we were there when lunged on concrete he marches around more confidently than most horses with shoes on so he’s pretty certain there’s nothing lower down in the foot or anything.

But both vets (and me) seem to be stumped of what to look at next. And as you can imagine we’ve burned through quite a bit of the insurance money ? He’s only 8 and relatively low mileage, I really don’t know if we’re going to find the issue ?

If you got this far thank you and if you have any ideas thank you!
 

Flicker

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Shuffley trot, ears back, head up, handbrake on - reminds me of my mare who had Sacroiliac dysfunction. It can sometimes be secondary to hock issues, sometimes it is primary - ie an injury to the ligament structure. My vet did a number of diagnostic procedures in the stable at first - tail pulls, pressure points etc. At one point she nearly sat on the floor when he prodded her. Then we popped her on the lunge - she was only ever really 2/10 on a circle in terms of her gait abnormalities but her facial expressions and reaction to pressure indicated she was in a significant amount of discomfort.
If it was my horse, I’d be tempted to look there. Good luck x
 

ycbm

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Really feel for you on this one. Very frustrating not to be able to find anything after all that investigation. I've heard something similar, caused by problems with the spine ligaments.
.
 

maddielove

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Lumbar/SI weakness/stiffness compensating for hock soreness, I had my mares hocks injected about a year ago but didn't get any improvement until physio got properly involved. Getting things strong again needed a complete change of workload to build proper strength without any compensating for hock pain, not out of the woods yet but so so much better than a few months ago with lots of walking in straight lines, poles, equiami.

PSSM is one on my list to look in to as well.

Edited to add, a new farrier was also advantageous to us as I think low heels were part of her issues too. Another place to look at for issues potentially. Good luck to you!
 
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Lammy

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Thanks all, should have added physio has seen him throughout and is very involved bless her. Said back/pelvis all feel fine even got her to check the saddle she’s convinced it’s not causing him any issues. Did tail pulls and other neuro investigations as well and he was all normal. Both vets have also palpated his back and said it’s very loose and supple.

I did ask about SI/pelvic issues during one of many trot ups/lunges on concrete and the vet said something about generally being able to see some degree of lameness when lunged on hard ground. Which he isn’t lame. The gait analysis only just managed to pick it up and then obviously more apparent when the leg was blocked. But on the most recent set of nerve blocks he was sound as a pound which was after the hock injections. But thank you definitely something I am going to ask about again.

Those suggesting PSSM, would it get better with bute? It doesn’t strike me as something that would improve like it has done.

I will tentatively try him bareback, not a silly suggestion at all and one I had been thinking of but he’s not the easiest horse in the world and I think it would just have to be in trot. So frustrating as he is sound and forward on the lunge so it has to be something the added weight of a rider is doing.

Also no stifle X-rays but surely they would show on the bone scan if other places did that weren’t even an issue? But something to think of thanks!

Thank you all for the suggestions. At my wits end with this one so jumping off points are so so helpful when you feel like you’ve looked everywhere ?
 

hock

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My gut instinct is PSSM. And I think the treatment carried out so far and improvements could be inline. Does your horse lie down? Roll?
Other than that maybe last steroid injections had worn off and the horse is hypermobile with a previously strong core which you unknowingly haven’t maintained. Maybe now the hocks are done the horse could be worked daily to really strengthen his core - under veterinary advice obvs. I saw you mention how correct and loose he was in his top line.
It’s slightly annoying his stifles weren’t ruled out by X-ray but your vets/you sound savvy so assuming there’s a reason not to bother.

Failing all of that I’d want to know more about his last 6 months leading upto March, fitness, feed, turnout, comp, conformation.
 

DabDab

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When my Pssm horse was having an episode, Bute did help him significantly. I assume it lessons how much they feel the muscle soreness even if it doesn't loosen the muscles
 

McGrools

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How frustrating!! You have been very thorough in your investigations. I find it significant that he lunges well but backs off with a rider up top. I teach a kids pony that does exactly that. Shuts down in a nappy way with the child on board but looks a picture of health on the lunge. I will be very interested to follow your progress.
Have you tried putting other riders on board?
 

rabatsa

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What is he like loose in a field? Does he trot and canter freely? My SI horse has never been lame but went shuffly and refused to go forwards in the carriage, he also went stuffy in his trot and bunny hopped his canter in the field.
 

Lammy

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My gut instinct is PSSM. And I think the treatment carried out so far and improvements could be inline. Does your horse lie down? Roll?
Other than that maybe last steroid injections had worn off and the horse is hypermobile with a previously strong core which you unknowingly haven’t maintained. Maybe now the hocks are done the horse could be worked daily to really strengthen his core - under veterinary advice obvs. I saw you mention how correct and loose he was in his top line.
It’s slightly annoying his stifles weren’t ruled out by X-ray but your vets/you sound savvy so assuming there’s a reason not to bother.

Failing all of that I’d want to know more about his last 6 months leading upto March, fitness, feed, turnout, comp, conformation.

I’ll definitely query PSSM, he does lay down and roll I’m not sure if that’s good or bad? ? Thinking about it my old mare would “tie-up” never got a formal diagnosis as she only did it mildly once with me and that was because she had an underlying cold. She was otherwise managed to prevent it, low sugar/starch feed, long warm ups cool downs, muscles kept warm etc. Which has bled over to how I manage him bad the keeping him warm as he runs very hot so it’s more keeping him cool enough! He’s fed on simple systems grass chaff (not alfalfa) and their grass (again not the alfalfa) pellets in the winter.

He’s also only had his hocks done the once in at the end of June which has most certainly helped stop the tripping behind.
Post scope he was in full work, doing lots of pole and hill work to try and build the hind quarters which physio initially thought would stop the tripping behind. His muscle was much better by that point.

What are his feet like? The tripping just made me ask I always start at the feet and work up

Solid and pretty textbook annoyingly! I took his shoes off the day before we went back to the vets the last time and when they lunged him on concrete the vet remarked how good and confident he was in his feet. The tripping or ‘loosing a leg’ behind has now stopped due to the hock injections.

When my Pssm horse was having an episode, Bute did help him significantly. I assume it lessons how much they feel the muscle soreness even if it doesn't loosen the muscles

That is really interesting and it makes sense, hadn’t thought of that. Are there any other signs/symptoms of PSSM that I could look out for?

How frustrating!! You have been very thorough in your investigations. I find it significant that he lunges well but backs off with a rider up top. I teach a kids pony that does exactly that. Shuts down in a nappy way with the child on board but looks a picture of health on the lunge. I will be very interested to follow your progress.
Have you tried putting other riders on board?

So so frustrating. You can see how dodgy types get away with it as on the ground an on the lunge he’d pass a 5* vetting so he could easily be sold as unbroken. Obviously not doing that but it’s eye opening really!
 

Lammy

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What is he like loose in a field? Does he trot and canter freely? My SI horse has never been lame but went shuffly and refused to go forwards in the carriage, he also went stuffy in his trot and bunny hopped his canter in the field.

It’s funny you mention that as I was reading up last night after the suggestions here (whilst not being able to sleep) about SI and it’s made me really want to look into it again. So this morning I’ve searched through my many videos of him and found this of him in the field. It’s about a week after his hock injections…


He doesn’t do that on the lunge seemingly only in the field. So frustrated that I didn’t notice that short striding hind before. Although his “cantering” around the field is usually just broncing with some canter strides put in for fun.

If I want to look at the SI how do I go about it? Bone scan didn’t pick it up and there’s certainly no money left for another try. Ultrasound? Can you nerve block the SI? Although if that is the problem it won’t show in a trot up or on the lunge as it doesn’t now.
 
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Tash88

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Firstly sorry you're going through such a tough time, sounds like it's been a long road for you.

And I am replying late as started this post last night when there was only one response then my internet went!

I think Sacroiliac dysfunction makes sense, and I would also ask your vet to look at the stifles. They can be difficult to diagnose on x ray properly, but they should be able to pick up if something is wrong. Your mare sounds similar to my horse who was diagnosed with cartilage damage in his stifles nearly 2 years ago (now back in work following surgery). He always had a strong, marching walk but was 2/10 (left) and 3/10 (right) lame in his stifles, responding positively to the nerve block. He struggled most with his canter as well, and went like he had the handbrake on in the school as that's where he struggled the most.

Wishing you and your mare all the best x
 

coblets

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If the other suggestions aren't fruitful, I'd check out equibiome and get an acupuncturist in, just to cover all the bases.
 

Flicker

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It’s funny you mention that as I was reading up last night after the suggestions here (whilst not being able to sleep) about SI and it’s made me really want to look into it again. So this morning I’ve searched through my many videos of him and found this of him in the field. It’s about a week after his hock injections…


He doesn’t do that on the lunge seemingly only in the field. So frustrated that I didn’t notice that short striding hind before. Although his “cantering” around the field is usually just broncing with some canter strides put in for fun.

If I want to look at the SI how do I go about it? Bone scan didn’t pick it up and there’s certainly no money left for another try. Ultrasound? Can you nerve block the SI? Although if that is the problem it won’t show in a trot up or on the lunge as it doesn’t now.

It can be difficult to diagnose because the SI region is so massive that the problem could be in a number of different areas. Also X-rays etc don’t really show anything up if it is a ligament issue. Gamma scintigraphy could show up hot spots - it is expensive and if there is no inflammation it won’t show up anything.
My suggestion would be to try to diagnose based on clinical signs, examination and behaviour before imagining or scans. You may need a vet who specialises in equine lameness so potentially a referral to an equine hospital if you need.
They may also do a general nerve block process to ascertain if the SI is the primary source of pain or is just sore because he is moving himself in a certain way to compensate for eg a hock or stifle issue.
Really hoping you can get to the bottom of it!!
 

SusieT

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If we look at it realistically- if the signs are so subtle, and diagnosis so difficult is treatment likely to be easy/is there anything obvious to treat? Where might it lead you? Would 6 month off at grass be a more sensible route? Just something to consider. I'd also see no reason not to rescope- a recent scope doesnt rule out a problem now. It is tricky as the horse is such a large animal and we are limited by this - e.g. dog you might MRI the spine but we can't do that in horses, a third referral vet opinion is probably your only option?
 

Lammy

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Thank you for all the suggestions they are all helpful ??

After speaking with the physio and sending her that same video I’m definitely going to speak to the original vet tomorrow and talk to him about the SI and see what he thinks. Hopefully we’ll find something to treat.
 

Lammy

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Just updating this as I know this is an odd case.

So the vet injected his SI a month or so ago, he had a week off, a week of hacking and then has been back in the school. Hacking is great it’s like he’s back on the bute, he’s forward and keen, has had a few little canters and been pretty happy.

I schooled him in the arena just in trot for the first few times just to get him to relax which he did quite nicely and actually stretched down which he hasn’t done in months! However canter is no better still.

The first canter he did in the school was actually quite good, he did a full lap which is a lot for him, on the correct leg. But now since that first one he won’t do it again, it’s the same issue as before, if I can get him to canter it’s a couple of steps and he’ll fall out of it. His head is up, ears back and he’s very tense if you even think about asking him for a canter. Thought it might be the surface so I took him to school out on grass yesterday. He’s usually pretty hot and quite sharp and I would normally be worried he’d be a bit exuberant. Again he couldn’t do it, even on a nice flat grass area with much more room than in the school he still couldn’t canter or then maintain it. I don’t think I could have ridden him harder if I tried and really got after him, made no difference.

A friend on the yard watched and said she agreed he just still looks unhappy. I tried him on the lunge in the school also, popped a couple of raised poles in the corners to encourage him to get the right lead on his most difficult rein. He did it twice for a short canter and then just refused to canter again, I was practically chasing him and this is a horse who is usually nuts to lunge. I don’t usually need to hold a whip, raising my arm is enough, let alone chasing after him with a whip in hand.

I just don’t know what to do, there’s still something to find but where do I even look? He’s got about 1k left on his insurance. Suspensories maybe?
Sorry this is so long. Any suggestions appreciated.
 

ycbm

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He's had so many things investigated already that it's difficult to know where else to look. If the suspensories have only been blocked, not scanned, then I would do that because my understanding it that PSD can be as much a functional problem as a pain one.

If that shows nothing, then if you aren't insured for loss of use, it sounds as if your best bet would be to turn him away completely for the winter, preferably out 24/7 in a big field in a herd, and see what the situation is in spring. If you are insured, I'd try for the loss of use now and then turn away once it's been paid.
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OrangeAndLemon

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Sorry if this comes across as rude but it never hurts to check your own riding and position to make sure you aren't part of the issue, particularly as you've had improvement in other areas.

Do you have an RI or someone who you trust to give him an expert ride (not saying you don't, just saying I'd get someone I know is an excellent rider, but doesn't know him) see what happens with them on board?

I get a 'tune up' every now and again to make sure I'm riding straight and supporting my slightly wonky horse and not making it worse (and everyone rides him better than me :D)
 

ycbm

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