31yo arab gelding severe ataxia

[Janet_Conway]

I have a 31yo arab gelding in distress, and hoping someone has had experience with this situation. My arab is on lush pasture, fresh mountain creek water, with his four lifelong companions. He has excellent conformation, is in very good weight, goes through all gaits with ease, and has been a perfectly sound and healthy horse his entire life (I’ve had him over 17 years and know his detailed history from birth).

Thursday afternoon, I thought he had a stroke because out of nowhere, he could no longer walk and could barely stand. However, his mental faculties not affected, as he called for me when I walked over to him, and was happy to eat treats. Eating/drinking/peeing/pooping all normal. His tail continued to swish flies normally, too. My vet was there within 30 minutes, and said he believes there is a compression along spine causing his brain to not know where his feet are. He said it could be a tumor, but likely osteoarthritis causing a floating bone chip lodged somewhere. He gave him 10cc I/M dex, with instructions to continue regime 2x daily for next 5 days. He said he has seen good responses to steroids, and we may be able to manage condition, but no real definitive prognosis.

After about 8 hours (and him going down to where I was convinced he was dying), he turned a corner and was able to stand up and sort of walk forward again. Yesterday, he became more mobile and is walking/grazing, hanging out with his favorite horse, but he still acts like a sedated horse, and is very unsteady and out-of-it. No change this morning from yesterday.

I am extremely worried about my horse, and do not know what to expect. My local horse friends are at a loss, since they have never dealt with this condition. So I hope that someone on this forum may be able to offer guidance, personal experiences, or suggestions on how I can help my horse recover.

Thanks,
Janet

[Equisis]

Sorry you’re going through this. What did the vet do to make this diagnosis? Physical exam? Any signs of recent injury? Was blood pulled? Any discussion of disease? There are a number of things that can cause acute neurological symptoms, some treatable with a good prognosis, some not. The outlook is going to depend on exactly what is wrong with your horse.

[S1969]

This happened to an elderly QH that I boarded several years ago (he was known to be at least 32 years old at the time). Almost exactly the same description of the issue and recovery. He did get a little bit better but never recovered fully. It happened at the beginning of July and the owner had him euthanized in about October. I was very concerned about him being ok in the fall/winter - worried that every day I would find him splayed out in the mud and unable to get up, or falling on ice.

I’m sorry. There were theories that it could have been EPM (I can’t recall what bloodwork was done but the vet felt a spinal tap would be necessary to confirm) and at his age it wasn’t a great option. Possible brain tumor, floating chip, etc. We never did find out. He lived a pretty good life until then and even afterwards didn’t seem terribly bothered by the ataxia. We made sure his last days were good ones.

ETA: wow, except for the blaze it could be the same horse.

[Toblersmom]

Something to keep in mind is that horses that have neurologic signs that include “unsteadiness” can be dangerous to themselves and people and other animals around them. Unless the signs are very, very mild (like only apparent in a tight turn, and barely), there aren’t a lot of circumstances where I would consider trying to manage a horse with noticeable unsteadiness (technically called ataxia) in a normal barn setting, and I’m not coming up with a lot of circumstances that I would consider trying to diagnose and treat a 31 year old gelding at an appropriate hospital setting (with slings, hoists, and such to be able to work with such horses without worrying about them falling over and breaking a leg or smooshing somebody). Unfortunately, this falls fairly firmly in the category of “better a month too soon than an hour too late” for me. Particularly given that onset of signs was acute—recurrence and worsening of signs may very well be just as sudden, and entirely unpredictable.

[Huntin_Pony]

While I agree with Toblersmom about the risk to both horse and handlers (be careful), my at-the-time-30-year-old horse had a sudden onset of ataxia that turned out to be EPM. We treated him for the EPM and he recovered over a period of months then lived happily and with full function for an additional five years.

In fact, I finally had him PTS a year ago this month due to a failing heart. I’m glad he had those five good years.

[Marla_100]

Is your horse vaccinated for West Nile virus? August seems to be the worst month for this to show up. I’d also mention this and viral encephalomyelitis (EEE and WEE) possibly can mimic neuro problems.

[Janet_Conway]

Thank you for the replies! They are very helpful and give me much to think about.

Red (my arab) is now in our 1acre yard around house, just so we do not have to worry about our other energetic horses around him or him falling somewhere out in the pasture. Only our geese/ducks/chickens are at real risk of injury. Our dogs/cats stay clear and my husband and I are alert and careful. We have a mare in a stall in our barn, so Red freely comes/goes and visits with her when not grazing. Our vet prefers he be out in open space on soft grass in case he falls. I do not consider him safe to travel, so diagnostics are limited to what our vet can provide on home visit.

He has not been vaccinated for West Nile. We live in Park City, Utah, and no reported cases in our state this year and extremely rare historically. Vet immediately ruled that out of consideration. Vet mentioned EPM, but also felt unlikely because it is also highly unusual where we live.

S1969, do you recall how many days it took where horse was making progress recovering until plateau? Do you remember if the horse required steroids daily for rest of life? Was there anything else added or done differently with horse to increase quality of life, such as adequan, previcox, cbd, acupuncture, chiro??

[S1969]

@Janet Conway

S1969, do you recall how many days it took where horse was making progress recovering until plateau? Do you remember if the horse required steroids daily for rest of life? Was there anything else added or done differently with horse to increase quality of life, such as adequan, previcox, cbd, acupuncture, chiro??

I don’t recall exactly but it was only a couple of days on steroids; I know because I was actually away for a rare weekend trip and my boarder was farm sitting. I felt really badly about it because it was a lot for her to deal with alone.

I honestly don’t think he got a lot better after the first couple of days. I think he got a little stronger after recovering from the incident - whatever it was; the boarder came to the farm in the morning and found him down, so we never knew exactly how long he had been down (less than 10-12 hours, but not sure). I don’t really think he regained a lot of balance after that, though. And we did not treat him with anything else. He actually seemed quite cheerful and ate well, but obviously something was seriously wrong.

I definitely agree with the posts above about making sure you are super careful and thinking about quality of life for the horse and for you. This guy was hitting his back legs with his feet, causing nicks and cuts that attracted flies. I remember wrapping his legs to try to protect them and thinking “I must be crazy!” because I never trusted his balance 100%. He never fell, but it was scary to watch him sometimes. He would occasionally trot or even canter a few steps and I never knew if he would make it through the gates without hitting the posts.

If I had owned him, I would have had him euthanized earlier. The owner didn’t want to, and I had to actually tell her she would have to move him before winter if she didn’t euthanize him. I would have been so heartbroken if I had found him down in the snow or on ice; I wouldn’t have put him through that.

Sorry to be so doom and gloom. In retrospect it might have been worth treating for EPM, even without a clear diagnosis. Maybe something to ask your vet about.

[joiedevie99]

I had a senior OTTB present somewhat similarly many years ago. Out of the blue, she couldn’t walk straight. She could take a few steps, but they were very sideways in the hind end. From the shoulders forward, she was normal. Vet assumed EPM and began treatment immediately. Blood was sent off for testing, but it came back negative. We discontinued the Marquis and DMSO, and started high dose steroids on the assumption that there was spinal compression, possibly from a tumor. She responded quickly, and was 90% better within a week. She had a few relapses (about once per year), but always responded to the steroids. It was probably another 4-5 years before I lost her. I think the whole story is posted on here somewhere.

If the symptoms hadn’t been localized behind the withers, we’d have x-rayed/ultrasounded the neck that first day too.

She was also too unstable to travel, and had a lot of other issues. Had we not been able to get it under control quickly on the farm, I wouldn’t have hesitated to let her go.

[Huntin_Pony]

Janet -

I see that you have had this horse a long time and know his entire history. So has he always been in a relatively EPM-free area? From what I understand, EPM can hide for a long time and an older horse/weaker immune system is more susceptible to symptoms.

My vet did the same as joiedevie99’s and started EPM meds before testing. In my case, the improvement was immediate (although full recovery took a while) and he did test positive for EPM.

His symptoms were quite severe. He could not stand in one place at all. I had to follow him around with his feed tub so that he could eat. He would circle to the left and you could see from his face that he didn’t want to be doing that but couldn’t stop. It was awful, but fortunately not for long.

Had he not improved quickly, I would have let him go. You sound like a wonderful caretaker for Red. He’s a lucky boy and I’m sure you’ll do what’s best.

[pony_baloney]

My 34 yr. old Arab just had something similar. We started treating for EPM immediately before test results came back but after three days, he went down for the third time (in a stall this time) and was so scraped and cut up that I couldn’t let him go through more episodes and had him euthanized (exactly one month ago yesterday). Afterwards his EPM results came back very high, one of the highest the vet had seen.

He started out just being a bit unsteady, not knowing how to move his hind feet out of his way. Acted normal otherwise. She IVd DMSO from the start and we used the generic Oroquin 10 but as I said, only was able to treat for three days.

I hope your horse recovers from whatever he has.

[Janet_Conway]

I’m so pleased I posted on the forum, as I appreciate all the answers and comments. As of this morning, Red has shown a little more improvement, putting him at about 50-55% better in my view. My vet responded yesterday via text to continue 10cc dex 1x daily for next 3 days, then stop. He does not believe my horse will recover fully, but is encouraged that he will be well enough that euthanasia is not in the immediate future.

I still think that if spinal compression, relieved by reduction of inflammation by steroids, that there is something to adding adequan/previcox/cbd to help. I have my elderly dog on this med combo and it is the miracle treatment for her joint disease. I have also used acupuncture on dogs and myself, and feel there is potential value there for Red.

Huntin Pony, Red was born in northern cal, did halter showing in Scottsdale, then moved to Wash state as a 3yo. He was moved to Utah as an 10yo, where I got him. We moved to central Florida from 2003-2005, but Florida tried to kill my favorite quarterhorse (anhidrosis, sweet itch), so I moved the whole family back to Utah. You make a good point that I should not rule out EPM and will bring it up with my vet when I speak to him tomorrow. Is DMSO the usual treatment? My local friend suggested massaging DMSO into muscles along spine or even injecting it… but she thinks DMSO is the wonder drug for all ailments in horses and humans… so I didn’t give it too much consideration.

It is extremely interesting and helpful to hear everyone’s personal experiences, observations and suggestions. I tend to be the kind of person to bankrupt our finances trying everything to save my pets, but I also am very sensitive to his age and not putting him through any unnecessary stress.

For what it is worth, my arab is a total ham and clearly loves the extra attention, grooming, and unlimited treats. Something tells me, he will adjust well to life in our yard and already has us trained to wait on him 24/7. Quality of life is always our #1 priority and I am sure I will obsessively watch my horse for signs that he is ready to cross the rainbow bridge. He is definitely not there today.

[poltroon]

It looks like you’re in a good place and he’s doing better, which is wonderful.

If he hadn’t responded to the steroid, I would also look at his nutrition and consider nutritional supplements. When they get older, sometimes they don’t absorb all the nutrients they need, and in particular I’d be thinking of vitamin E and selenium, which can both cause this kind of issue if they are deficient. It’s a little expensive and unusual to test for so it’s not often done. But it’s straightforward to supplement.

[joiedevie99]

If he spent any time at all in Florida, I’d test for EPM. It’s unlikely given the time frame, but definitely not impossible. It can lay dormant for a very long time, and show up when the immune system is compromised due to another issue. Glad to hear the steroids are helping. It’s very good news, but doesn’t necessarily pin down a diagnosis.

[Huntin_Pony]

Janet - I’m rooting for Red! Sounds promising already.

As for EPM treatments, there are several that have been discussed at length on CoTH (probably searchable). As for my old boy, we used Protazil and he only needed one course of it. As I said, it was several months until he seemed close to normal again but the acute phase was thankfully brief. I’ve never heard of DMSO for EPM but I’m no expert.

I also work with a very talented homeopathic vet and she gave me a remedy called Lathyrus to use when he showed any signs of incoordination AFTER his initial recovery. This was very effective for him for the rest of his life. If I saw him in a little “haunches in” coming to the barn for breakfast, I’d add the remedy to his breakfast and he was usually straight by lunch time. (I know homeopathy is controversial and I’m a skeptical individual but it helped my horse and cost little, so what the heck?)

Very best of luck to you and Red.

[joiedevie99]

The EPM - DMSO connection is not a proven one, but some vets like tube the horse with Marquis and DMSO for the first 3 days of the 28 day Marquis treatment. They also use a double dose of Marquis for the first three days. Some vets believe it acts like a loading dose - getting the drug up to therapeutic levels in the system faster.

It’s not a topical application of DMSO.

[S1969]

@joiedevie99

It’s not a topical application of DMSO.

No, it’s a very stinky IV treatment. I’d never experienced it before the QH I described above, but will never forget the smell. I had forgotten that was an added treatment.

[Janet_Conway]

Thanks for the continued flow of information and words of support! It is much appreciated! Red is steadily improving. He is pretty solid on his feet again, although still weak and tired, and I am not sure how he would do at trot. But I am cautiously optimistic that we are out of the woods for the immediate future.

Based on ataxia affecting front more severely than rear, and rate of recovery after receiving steroids, I would not be surprised if the issue is arthritis-related problem in neck. I texted my vet to ask about additional support with adequan, previcox, supplements, acupuncture and/or chiro, and am waiting for response. I also left voicemail with equine back care specialist, and am waiting for response.

[2tempe]

OP - dont presume that cervical arthritis can impact front more than back. I had a TB gelding with CA diagnosed via xrays; his issues were primarily hind end. In any event glad to hear your old man is improving. I would keep in mind that this problem, whatever the cause, may make it difficult for the farrier to work on him. As I saw mine starting the downhill trend, I had a good talk with my farrier and made him promise that he tell me if he was at all worried about his own safety. Presuming arthritis, I would suspect that adequan will not have any significant impact. Nor will supplements. Previcox or other anti imflammatory would be your best bet.

I am puzzled re the apparent sudden onset - the few I’ve known with cervical arthritis showed some NQR signs that did not immediately raise red flags. So maybe its not CA but something else?

[Janet_Conway]

Red appears to be tapering off recovery now that he is off steroids, but still overall doing pretty well. I had a good discussion with my vet about additional support, and he is having me start with a round of bute for next week, and then possibly switching to previcox from there, depending on how Red responds. He also is having me add Elevate Vit E supplement. However, he did not feel adequan shots would add value. Finally, he thought Red may benefit from chiro (not so much acupuncture), so Red has a chiro appt Friday morning with a specialist that my vet likes.

Fingers crossed… I’m still shooting for a 100% recovery, and believe Red has many more good twilight years left.