Coughing and head shaking can be symptoms of epiglottis displacement, DDSP. Definitely have an expert take a good look at his airways and do a dynamic scope.
This most likely happened to my mare. I took her in for teeth and the vet noticed she had a floppy ear that hadn’t been like that. I had noticed she’d been rubbing her face a lot recently. When we had her sedated he found mites down deep and put stuff in her ears. She was fine after that. She still has use of the ear, it’s just floppy when relaxed. My old timer farrier said it used to be a pretty common finding and it almost completely disappeared with regular worming.
My first thought was nerve impingements? Or neck arthritis. Maybe look into the Balance Through Movement Method, it’s been helpful for a lot of people which these types of issues.
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With the coughing, I would also do a BAL to rule out asthma. My heaves horse coughs and blows so badly she trips when she is having a flare.
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Was your horse previously bedded on straw? What bedding, if he is stalled, are you using now?
The cough makes me think of a bedding issue. Just one more thing to consider.
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Another update from the vet appointment I had last week.
Basic bloodwork (included Lyme test) came back normal. I also caught a few instances of him running around in turnout and doing the headflipping there as well with nothing on his face, no pressure, etc. It’s truly just head flipping/tossing typically when he’s trotting/cantering - no nose rubbing or anything like that.
Last week I had my vet scope his airway (without sedation), his gutteral pouch (both sides/nostrils), and both ears. There were two very mild findings - 1. it does look like his airway has some very mild inflammation that suggests allergies, but it’s mild and there was no mucus buildup anywhere. No foreign objects lodged anywhere, everything looked structurally normal. 2. His right ear was irritated on the inside compared to the left (redder, more wax buildup) but nothing crazy.
So we are currently in the midst of doing some basic tests. I dewormed my horse again just in case there are mites in that right ear (we didn’t see any) and he’s getting antifungal ear drops to help the irritation in the ear.
And now we are doing a three part trial: Part 1 - a week of bute to rule out pain (complete / no change in my horse’s behavior). Part 2 - steroids to rule out broader allergy issues (in progress). Part 3 - gabapentin to rule out nerve pain.
If none of these yield results I’ll probably send him somewhere for a more thorough work up including a dynamic scope, BAL, and god knows what else. I’m in the Northeast/New England USA so if anyone has recommendations for equine hospitals with good diagnostics feel free to throw them out.
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Did I miss you saying you also were trying some ulcer meds on him? You sound very thorough so I might not have seen it. Even 3 days should tell you something.
Best of luck to you. You have got to be worried. He sounds really uncomfortable, poor guy.
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A couple of things that I have not seen mentioned here yet. I had a TB/QH gelding that developed a headshake at about age 20. No change in environment or feed, had lived in the same place for 5-7 years at the time. No findings by vet, all tests normal. No change with antihistimines. I started him on Spirulina (HorseTech algae powder). Took a few weeks, but it made a tremendous difference. I also changed feed to Triple Crown - because they do not change ingredients due to price fluctuations (those get passed along to the consumer), BUT there are no “surprises” like increased soy. Horses can develop sensitivity to soy over time, and it is used in a lot of feed to add protein.
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Another update after a couple more months of diagnostics.
My horse was on a bunch of different drug trials - heave relief, zyrtec, bute, and steroids. We basically weaned him on and off each drug at a time and I reassessed him on the lunge line at the beginning/during/end of each trial. The ONLY thing that seemed to cause him any relief was the highest dose of steroids we gave him, but it wasn’t 100% resolved. His coughing and sneezing seemed to be lessened but not fully eliminated and honestly not the bigger issue compared to the (now violent) head tossing.
I pulled him off everything and he seemed more or less the same, so I reconvened with my vet. We decided to do neck x-rays since we hadn’t yet. They were also unremarkable and normal.
So we pulled blood again to specifically test EPM and Vitamin E levels. My next step would have been to send him to a clinic for a full work up BUT he is (low) positive for EPM and has just below acceptable Vitamin E levels.
I’m going to load him up with Vitamin E and do a 28 day round of Marquis for him and then reassess.
I’m not a vet but I’m honestly shocked it’s EPM. The head shaking was the really “bad” symptom, beyond that his assymetrical muscling was the only other thing I could point to that really suggested it.
As a lurker, I always find these diagnostic threads super helpful so I’ll keep updating as we go through treatment.
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One month of Marquis (+ Vitamin E + a probiotic) down! The good news is that we are seeing SOME improvement. After two weeks on Marquis there was NO headshaking on the lunge line, and that continues to be true. I’ve been popping on my horse once a week to just tack walk for 10-15 minutes. Every single ride has been better than when he was at his “worst”. My latest ride (today) there were only a few instances where he was head shaking/tossing. I am cautiously optimistic we have found the right root cause.
My vet wants to do another month of Marquis (RIP my wallet) since we seem to be on such a positive trajectory and wants me to start riding him regularly again. It will be the classic muscle build up given he’s lost all his condition, I’ll probably work up to 25 minutes of walking before I even think about throwing in trot, but cross your fingers we are on the right path…
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I don’t have anything helpful to add but this is a really fascinating thread and I’m glad things are headed in the right direction!
Is it possible to put the link where you got the spirulina powder and also the dose? thank you
Horsetech.com. Spirulina is listed under Basic Ingredients. Dosage is provided by Horse Tech. My horse (about 1100 pounds) was on 1 scoop per day maintenance. There may have been a loading dose. I cannot recall, as he started on it more than 10 years ago.
It’s been a while so sharing another update…
We did a second month of Marquis. During that time my horse’s improvement stalled a bit. He was now rideable but still “not quite right” and not enjoyable to sit on. I was only tack walking and adding 5ish minutes of trot in here and there just to see how he felt.
The head flipping and shaking was still present but WAYYY less so - the issue was more that he didn’t feel totally sound underneath me. In addition to the head flipping and shaking he was also rooting at the bit and occasionally swishing his tail.
It’s been about 3ish weeks since I stopped the Marquis treatment (he’s still on Vitamin E though), and while he hasn’t continued to improve he also hasn’t gotten worse.
I had my vet out this week to reassess him and pull blood. I had my vet watch me walk trot under saddle and then do some flexions to help gauge the “not quite right-ness”. My vet said he looked a bit lame behind and when he flexed his stifles there was a noticeable difference in his soundness (this was not the case when I did his PPE almost a year ago).
Sooooo the new theory is that maybe there was EPM, but now he probably just needs his stifles injected to get him to 100%. We injected them today so I should know pretty soon whether that was the last piece of the puzzle and I can enjoy riding my horse again.
I plan to take it very slow with him since he’s not fit and slowly do a lot of stifle strengthening exercises to help him. Cross your fingers.
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So unfortunately not the update I was hoping to share. Right after we got our stifles injected he caught his left hind fetlock, which blew up, so it took a bit to get that resolved. He now seems… worse? The headshaking is back again. Which could mean we have no idea what the underlying issue is, it could be that it’s EPM that’s coming back, or if could be that the steroid injections somehow made things worse?
I have a couple options I’m going to discuss with my vet:
- Send him somewhere for a full diagnostic work up. This will be very expensive and inconvenient for me - the nearest place is hours away and I do not own a trailer. If I have to go “with him” that makes it even harder.
- I spend the next 1-2 months just trying to build up his strength with ground work only to see if that makes a difference. He’s uncomfortable under saddle, even just walking around he is flipping his head constantly, but in hand he doesn’t show the same issues.
There’s also a part of me that worries I am making the situation worse, somehow, and my horse might benefit from going to a rehab facility to strengthen up. I am very burned out from dealing with horse issues - I had to put my older heart horse to sleep last year and had a 3 year diagnostic struggle with my only other horse who is now retired for good. It’s frustrating having a “new” partner that has been basically unrideable for such a long period of time.
Not sure if anyone has experience with the “just rehab with groundwork super well and hope for the best”. I don’t love that idea because I would like to better understand the root cause, but it’s low risk and less expensive than the alternative.
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Did you ever try gabapentin?
Have you considered just leaving him on compounded ponazuril for awhile (so cheap: https://www.farmvet.com/Ponazuril-Powder) or treating with a different EPM med?
Steroids can definitely cause a flare of infection type things (like EPM) because they impact the immune system. That he was going pretty well after being treated for EPM and then regressed following steroids perhaps just indicates he needs more EPM treatment.
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I had a pony that threw his head whenever he was tense, upset or just anticipating being fed. It was always the same circular motion, always in the same direction. We didn’t know his background as he was bought at auction by a rescue. The only way he could be ridden was with a running martingale. When I switched him to driving, he didn’t do it very often when we were out and about, but it sure was a pain when he did do it, as he would catch a line someplace it didn’t belong.
We never figured out the cause, but once he was retired from driving in his 30s, he didn’t do it very often at all. We moved him to South Carolina (from Colorado) with us, and he did it even less in the warmer climate, which he preferred. This horse never liked being cold, even with a good blanket. I think the head throwing was just his way of expressing displeasure.
Rebecca
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Is it possible to just start hacking him out, maybe pony if he feels that bad under saddle? Maybe giving him a bit of a distraction (scenery) will help him focus on moving along, which will help build his fitness?
(I know I suggest hacking out for a lot of things, but that’s because I believe it fixes a lot of things!)
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It seems we have the exact same horse problem. My horse has had a head shaking, bit-grabbing problem for a long time, actually ever since I bought him. About 18 months ago, he was having some odd lameness issues where he was slightly off and vaguely not right. It took my vets months before testing for EPM. He was positive, so I started treatment with Protazil and ulcer meds. (EPM can cause ulcers.)
He improved, but was still not right. This summer, the connection problems got worse, so I had major work-up done. His head, back, TMJ, and stifles were x-rayed. The X-rays revealed remodeling in his stifles. Why, I have no idea. He has never been in “hard” work. He was injected with a steroid and polyglycan. The improvement was dramatic. The fussiness with the contact is almost gone.
His EPM titer levels have dropped dramatically, from 2560 to 320. I’ll keep him on a 1/2 dose daily of Protazil until the number drops below 40.
If your horse was diagnosed with EPM, there is likely nerve damage that makes it hard for him to use his muscles properly. I think you are on the right track to do ground work. It takes a long time to regenerate nerves.
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