Bilateral hind end soreness, X-rays clean

[AllSport]

I’m chiming in because I read the title and thought, “Oh, that’s me”. Then I had to remind myself that I am not a horse. You’re horse and I do sound alike this week. So for what it’s worth I’ll tell you my pain and you can do the horse conversion for that.

I was doing that thrill seeking, dangerous task of teaching my son to mow the lawn last weekend. Some how I tweaked my lower back, as in the lowest part of my spine around the pelvis. If I were a horse I think I’d be acting like yours right now. Moving constantly is the only thing that feels okay, but if I have to sit or stand still at all, I start hurting immediately. It’s very odd and a new one for me for sure. I can kind of jog but it doesn’t feel great so real exercise isn’t happening, but being still isn’t either. I should go to the chiro but I’m not sure if this is a time thing or a chiro thing so I’m a bit nervous. If I figure out what helps, I’ll let your horse know!

[J-Lu]

I’m so sorry OP!

I personally would start with scoping for ulcers. What did you treat with before and for how long? It doesn’t cost that much. I’d also spring for radiographs to rule out kissing spines. I mention this because this is a route I’ve gone down.

I’d also really think about her inconsistent work. Does she need consistent work?

My horse was an explosive youngster, negative for all sorts of things. Scoped for ulcers and had very mild ulcers, we treated anyway. Some days he was good, some days he was afraid of the world. Circumstances and trainer broken collar bone led us to a very good NH guy who was taking dressage lessons with a USDF founder trainer. In sum, the NH stuff was most valuable to direct or redirect his particular brain. But it took a while. Even the NH guy says “I have no idea why this is an issue but that isn’t”. The NH stuff taught him how to learn, and that helped him how to learn my dressage training. But this took progress over years.

If you have access to a quality round pen, consider longing without the longe line and in an enclosed place to see how your horse really goes. I’ve also longed enough (in side reins) where I can free longe my horse - no tack- in a circle around me in the large arena and he listens to voice commands. This is a fantastic way for me to see his unencumbered movement. Plus, it functions as a training exercise.

Ohhh, 4/5 lameness score trotting is significant. Are you confident she wasn’t on maintenance drugs during your original PPE? Just wondering.

[ratchet]

Thank you! Yeah, I’m willing to do all the radiographs, scopes, and ultrasounds and bloodwork needed but not sure if I can afford a full body bone scan or MRI at this time…hopefully it won’t come down to that.

We did the Nexium protocol for a month and then a slow taper (after reading a big thread here about that). I forgot to mention that she has also been on a SmartPak Gut supplement (I think Ultra) for several months before I switched her to probiotics since she is already getting alfalfa. She was in inconsistent work at her last home too (the one that got her from the track) and according to that owner, never put a foot wrong once they started riding her after her let down period of a few months. It seems like the behavior and lameness began about a month after I brought her home.

There is one riding video from before I bought her, where someone I know mentioned that she looked kind of odd at the trot but to me it didn’t seem like anything. I’ll see if I can find that again.

I will take some video when she is observed at the clinic as I hope to be there. I don’t think I have any current videos that show the oddness well. And, it’s not like we’ve ever lunged the snot out of this horse either. I trust her former owner enough to believe that she didn’t drug her. They’ve been trying to help me troubleshoot and have put me in touch with their own vets as well, we’ve stayed in contact since I signed the bill of sale.

[J-Lu]

Well, the Nexium protocol should have taken care of ulcers. Hmmmmm. THe alfalfa and supplement should really help rule this out.

Are you confident in your farrier? (Grasping at straws here) So glad the former owner is working with you What you say changes the game in my mind. Is there any way to get the old farrier to review the new farrier’s work? Grasping at straws here.

[RhythmNCruise]

OP, I don’t envy you. I had a similar situation with my gelding, and trying to figure out what was wrong with him was so frustrating. The good news is…we DID figure it out and he’s a much happier horse now.

I’ll try to keep this short (yeah, no…that didn’t happen. Prepare for a novel…), but basically his issues started out as behavior (uncharacteristically spooky and tense and explosive). His back was definitely sore. I had a DVM chiro work on him twice and he HATED it both times. She said his back was basically going into spasms and suggested supplementing with magnesium (to help muscles relax), and working him over ground poles, and backing him a lot to strengthen his topline.

The magnesium definitely helped him be more comfortable overall (better for grooming and bathing…both of which he’d loved at one time, but could hardly tolerate anymore). I did the exercises over poles and backing as much as possible, but we didn’t have a lot of poles at the barn and because his back was still so tender, I wasn’t riding much. I longed and worked with him in hand, and really didn’t see a lot of improvement in his back.

Enter the new farrier/trimmer, who is really amazing. She saw immediately that his angles were not good, especially behind. She suspected NPA (not confirmed via x-ray, but just looking at his feet) and explained how this would cause issues in his back and loin (he was sensitive over his loin area). So, she started her work of correcting his feet.

During this period, his topline was sad. This was a horse who had been roly-poly with a crease down his back and rump. He’s an appaloosa with a halter bred sire and western pleasure bred dam. He was born stout and chunky, it’s how he’s supposed to look. His SI was prominent now, hip bones prominent, backbone prominent. Just nothing at all like he’s supposed to look.

Saddle fit was the next avenue we went down. I’d gotten a new saddle that I thought would work for him. I was wrong. Saddle fitter came out and made adjustments, admitted it wasn’t “perfect” but should be fine. Horse thought otherwise. I finally stopped riding in that saddle and on a whim bought yet another one (Wintec Isabelle). I had a feeling that he would prefer a lighter weight saddle, and the way the saddle is made just sounded perfect for him. This time I was right. He loves the saddle. It fits him perfectly.

With the new saddle and the new trimmer, lots of magnesium on board plus a good joint supplement, he started improving. Our biggest change came when I moved him to the barn/farm adjacent to the one where I’d been boarding. (Farms share riding arena and common riding places, just owned and run by different people). This place was a much better fit for my horse and me…smaller, more individualized care. We had been at the previous place for two years and my gelding never fully settled into the place. To this day, riding past that barn is the only place that he gets nervous and spooky. I don’t know if he still associates it with pain or what, but as soon as we’re past it, he’s back to normal.

Anyway, at the new place he flourished. Calmer, happier. Feet improving, diet improving (more hay, less “grain”), everything going well. Then last fall he went lame in the hind end. I’d never felt anything like it before, it was like he completely lost any drive from behind and couldn’t trot or canter. His trot felt like a gaited horse, there was no push, no two-beat rhythm. He was really struggling. It got to the point that he couldn’t lay down anymore.

Long story slightly less long…it turns out he has some significant arthritis in his right hock and a little in his left. Vet recommended Adequan and Equioxx, and that’s what we’ve been doing ever since (in the middle of his second series of Adequan shots right now, stays on a pill of Equioxx every day and will for the rest of his life if necessary). He’s sound as a pound, relaxed, happy, and looks like a million bucks with a nice topline. Back is never sore, trots and canters under saddle with no issues, loves being groomed and bathed again.

For the record, here’s the list of things that he eats and/or I believe have helped him:

• properly fitting saddle (that the HORSE says fits, not the saddle-fitter)
• change in farrier/trimmer and huge improvement in feet
• Magnesium (between all his supplements and ration balancer, he probably gets 16 grams a day)
• Daily pill of Equioxx
• Fed more hay than at previous barn (given “lunch” when pastures are dormant)
• K.I.S. Trace supplement (lots of good stuff including amino acids)
• ProElite Grass Advantage ration balancer (best feed he’s ever been on)
• Adequan (definitely makes him less creaky and more fluid and forward)
• SmartFlex Ultimate (no idea if it helps but I’m afraid to stop)
• Three Probios treats (soft chews) every day (has a healthy gut and good poop, so I don’t want to stop just in case)

[IPEsq]

Certainly you could have ulcers or something of that nature going on, since pain can make ulcers recur and/or difficult to treat. The horse might have the kind of ulcers that need different drugs.

But 2/5 on the straight and 4/5 on the lunge (with 5/5 being not weight bearing) is more than just NQR and fussy behavior. While it is great you haven’t found anything obvious in the lower limb, it’s harder diagnostically to pinpoint problems higher up.

Pelvis stuff can happen so easily. A slip and fall or other funky move in turnout. My horse hurt an SI joint based on a minor spook AT THE WALK, but very awkwardly knuckling over the right hind in the process. Resulting in a long time of NQR (though the vets said he looked sound) until I finally got someone to do a full back and pelvic workup following a face plant many months later (in part delayed because of COVID limiting my vet visits). A 4/5 lameness plus inability to pick up the hinds could even be a small pelvic fracture.

In my experience (including with a horse with significant axial skeletal problems who flexed clean a million times), not all vets are good with axial skeletal problems. And internal medicine specialists are yet another group you don’t often see doing barn calls. Bone scan might help since the lameness is so significant, but the results can be hard to interpret sometimes, especially where the horse is sore in a lot of places and compensating.

You can see some things on xray and ultrasound. Usually, if I’m going to do this, I just ultrasound the spine from poll to tail, including dorsal ligaments, and then move on to rectal ultrasound if the first one is clean. At the end, I still would have spent a lot less than bone scan. We are limited in what we can see, but generally ultrasound will also reveal any problems that could be caught on xray as well as things xray can’t see, so that’s why I would go straight to ultrasound. I also do neck and back X-rays with my PPE anyway, so I don’t feel the need to repeat the whole series most of the time. Usually any questionable images get saved and sent to radiology to confirm.

[ratchet]

I’m very thankful for the continued stories and advice, I appreciate every word even if I am not directly replying to everyone just yet.

So, this mare has been trimmed by the same farrier on a 4-6 week rotation since October. I’ve not been able to personally be there at any of her appointments, but the farrier would always text me after and say she did “great.”

Today I texted him and flat out asked if he has ever had difficulty working with her hinds. He told me yes, she is very sensitive back there and only tolerates it if her feet are barely lifted off the ground and if she is given frequent breaks — like horses with stifle or pelvic injuries (his words). There’s never any improvement.

You know…this would’ve been great information to have had. From him or any of the barn staff present. But it fits into the overall picture for sure.

She is on Equioxx at the moment and her appointment is next Monday, I will be sure to keep this updated and will also try to get more video. I do have one of her walking up to me this morning that hints at the oddness if anyone is curious.

[joiedevie99]

@ratchet

Equioxx

Call your vet ahead of any exam and see when they want you to stop the Equioxx. We strongly prefer to do these sorts of exams without any drugs in the system.

[ratchet]

I know. She will be off it 48 hours pre exam. We are actually dropping her off two days early so she can be hauled while still on pain support.

[ratchet]

Okie dokie. She had anther exam and an ultrasound today.

The gist of it:
Sore in both hinds, worse in right.
Sometimes worse at walk, sometimes worse at trot, but either way circles bring it out.
She cooperated today (different vet, I think this horse is just sensitive to people) and flexed positive on both hocks and stifles but X-rays and palpations were pretty normal. She has a tiny bit of arthritis in her right hock, really nothing that should be causing this amount of discomfort, and mild bilateral thickening of both hocks (don’t have the write up yet for the exact locations).
Feet and ankles look fine.
Still does the thing where she tolerates her feet being picked up to a certain height and then tries to slam them back to the ground.

Ultrasound revealed significant arthritis of the facets of a couple of her lumbar vertebrae, worse on the right side. I will add the vet’s exact words when I get her report. Vet thinks this corresponds with her symptoms. We are injecting this area with steroids – four injections total – and she will rest for 4 days on bute, the two weeks hand walking and stretches on Equioxx before a recheck at the hospital. If her symptoms don’t improve a bone scan at Big University Hospital was suggested (not something I necessarily can afford).

Vet didn’t think she presented like a horse with PSSM, neck issues, traditional kissing spine etc. Something odd like EMD still on table but that is of course a diagnosis of exclusion.

So. Lumbar arthritis in a 5 year-old. Most likely related to injury or hard training at the track. She was always going to be a low level horse but I worry about her riding career, if this is indeed the diagnosis. Steroid shots for the rest of her life – not a big deal. But I really don’t want to subject her to more discomfort even if the shots help her. I guess I will try not to jump the gun and first see if she responds at all to the injections.

[ala359]

I figured someone would have already said this! But you’re listing exactly the same symptoms my mare had/has from PSSM2…which when symptomatic also leads her to have ulcers. Obviously rule out other things but I encourage you (OP) to join them PSSM forum on Facebook. Vets don’t seem to be very helpful with this disease…

[ratchet]

Vet said blood test was unreliable and she would only do the muscle biopsy. If this mare doesn’t respond to the ‘roids I think I will ask for said biopsy!

In all likelihood, at her age with arthritis this advanced she’s probably looking at a retirement pasture. With us or some friends of ours. I will continue to pay for her maintenance and keep her safe for the farrier etc.

Such a bummer. Feeling really burnt out.

[JB]

@ratchet

Vet said blood test was unreliable and she would only do the muscle biopsy. If this mare doesn’t respond to the ‘roids I think I will ask for said biopsy!

EquiSeq does hair testing for this. I have 2 views on them:

• Dr Valberg has done enough research that has failed to find even reasonable correlation between positive muscle biopsy horses, and ES’s testing
• she feel that a very large % of the horse population would test positive for 1 or more variants
• meaning, she’s pretty certain that simply testing for a variant doesn’t mean they HAVE the disease, meaning it’s likely a mutli-gene disease.

That said, my other view is - if your horse is symptomatic and you test and find 1+ variants and alter the diet to what those horses tend to like (they do seem to vary based on the variant) and you find improvement, well, you can’t argue with that.

I hope the difference my (and I’m not alone) feelings on the validity of the hair testing is clear

There is no blood test for the Type 2 variants, but you can do that for Type 1 (and also hair which is very reliable)

[Tha_Ridge]

@ratchet

Such a bummer. Feeling really burnt out.

I’m sorry. Horses suck sometimes.

[Spud_amp_Saf]

Just wanted to say that testing for PSSM may not be the best use of your limited diagnostic dollars. If you are not getting any other answers, you can always just try a low NSC/high fat diet and see if she improves - there is no reason you can’t leave her on the PSSM diet if she seems to be responding. Given the lumbar findings, I would think those are your primary issue. I would see how the injections help the horse fare, and also try the PSSM diet to see if that provides any further insight.

Given her lumbar issues, you may also want to be really particular about saddle fit/length - this is not likely to be a horse that will be happy tolerating an even slightly too long saddle.

[JB]

@Spud_amp_Saf

Just wanted to say that testing for PSSM may not be the best use of your limited diagnostic dollars. If you are not getting any other answers, you can always just try a low NSC/high fat diet and see if she improves -

But, that’s not the most useful diet for type 2 horses. No, it won’t hurt, but in general, type 2 horses need more, and more quality protein. Type 2 isn’t a polysaccharide storage myopathy, so they don’t require the higher fat of the Type 1 horses in order to replace the fuel source.

Type 2 is generally a protein issue

[ratchet]

Thanks everyone. We are fairly sure this is causing her issues as the findings fit the clinical picture, but we will see. She came home today, obviously sore despite the bute. Official diagnosis is lumbar osteoarthritis of the right L1/L2 and L2/L3 facets (with significant proliferation) and additional remodeling in the left L1/L2 and L2/L3, as well as the right L3/L4 facets.

She had her saddle custom fit to her (and me), it’s nowhere near the affected area but carrying weight even at a walk a few weeks ago was blatantly bothering her.

I feel pretty rotten pushing her to lunge and long line thinking it was a behavior and training issue.

[atr]

Having had injections in my own lumbar spine, I can tell you that it can be pretty uncomfortable for a couple of days while all that fluid dissipates, so give it a few days.

[IPEsq]

Having done facet joint injections in other parts of the spine, it will take 2-4 weeks to know whether this will be a success or if the OA is beyond medical help to make her back to a riding horse. These findings are significant and very likely to be the root cause of the behavior.

[ratchet]

Yeah, I was told it will likely be about two weeks until it really starts to help her. Today is her last day of Bute, then back on Equioxx. Starting Mon I need to do some very light trot lunging daily until her recheck. Going to grab videos.

Vet thought the same and so do I, especially since they are more damaged on the right side which is the worse leg. And, she is reactive when palpated in that region.

Here is my goofy girl on her birthday in April before she knocked the plate out of my hands.