Can we start a reference thread for the various diagnostic options and technologies?

[Tiramit]

It seems that everyone I know lately has been flailing around with bizzare equine “issues” that have been difficult to diagnose and, subsequently, treat. These range from the typical mysterious lameness to immunological disorders to my own horse’s skewed tail. Vets from local clinics to very large hospitals have offered various suggestions as to how these issues can better be detected. I’m talking about MRI’s, bone scans, blood samples, exploratory surgery, shockwave, etc. For most of the people I know, these “tools” are new to them and have not been well-explained (especially the cost).

So how about starting a thread on the common and not so common options out there, what they show, what’s involved, and typical costs? If we get enough information, perhaps it could end up in the reference forum?

I’ll start (and please, add to my comments!) with one a horse I know just went through:

Bone scan (Nuclear Scintigraphy)

What is it? A process of injecting a horse with a radioactive / dye combination shot that results in a color-coded photo displaying injuries to the skeleton. The body is color coded by “activity”, thereby showing hot points where the horse has pain or discomfort. Different sections of the horse can be imaged - front half, back half, just the legs, etc.

What is done? The horse is injected iv with dye that attaches itself to all active bone cells and a radioactive compound. The drugs move through the blood stream and show skeletal damage and injury. Highly active bone will be more radioactive.

It’s a slow procedure, taking up to a couple of hours for certain images. The horse will be slightly radioactive for up to 48 hours after the procedure.

Cost? Anywhere from $900 - 2500.

[Tiramit]

Endoscopy (nickname: scope or “scoping” a horse)

What’s it for? Used to search out respiratory issues, ulcers, or other ailments in the horse’s system.

What does it involve? Horse is tranquilized and a long fiber optic endoscope is eased through a nostril to the area of concern. The vet can then view the area through the endoscope and, if he or she likes, take a sample or flush fluids through a special tube. Horses who are in for gastric scoping should fast prior to the visit to ensure a clear view of the stomach. An example photo.

What are the costs? Cost ranges from $150-400.

[Bea]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by Tiramit:
bumped up for the weekend crowd! <HR></BLOCKQUOTE>
And cleaned. Thanks to AmandaDVM I found out MRI will be available at Fairfield Equine in CT by end September. No pricing available yet. They have it available at New Bolton but not Cornell. Would love to hear if anyone has experience with this procedure.
Tiramit, I wonder if you’d be willing to do blocking? Another basic procedure like flexions it would be good to have here.

[Dune]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by Bea:
Dune, are you thinking of the MRI thread? By the way, if you’re interested in % of horses who are diagnosed with problems with MRI, there’s a good article on thehorse.com that gives numbers, doesn’t address that aspect just gives numbers. Or I could link you to a study on the ivis website that does the same thing. Mentioned numbers but doesn’t discuss follow-up. <HR></BLOCKQUOTE>

Thanks, Bea, I got confused…duh. Anyway, if you could link me to one or both sites, that would be great!

[Tiramit]

A happy update - I sent a friend of mine this link and, after reading Welshcob’s post, she is going to have an EPSM test performed on her horse. Welshcob’s description fit my friend’s horse, who has been to many different vets for tests and treatments but is still not quite right.

Thanks Welshcob!

[Tiramit]

bumped up for the weekend crowd!

[asterix]

MRI Report #2 (“What we found”)
I don’t have the heart this morning to give you the full history of my horse, Dune, but he’s had on and off heel soreness for 2 years, blocks sound there, has torn both medial collateral ligaments (R and L), came sound after 2 months off in a field, was sound for 9 months of eventing, still living in a field, and came up lame again on LF this summer.

What we found: he has a large tear of his DDFT, down in the heel. This injury is positioned in such a way that there is NO other way to diagnose it than an MRI. Because of this, there isn’t an enormous history of treating these injuries – not very many have been diagnosed yet – so his prognosis is uncertain. Dr. Allen was not, however, optimistic that he could return to eventing. It is possible, but it’s a big tear and tendons are not great things to injure to begin with. Most likely he will be a light hacking/light ringwork horse. He can be ridden now and he can continue to live in his beloved field.
If the horse is sound, you treat this injury with targeted shockwave. If he’s not sound, you inject the tendon sheath. The only way to re-evaluate how well the tendon is healing is to do another MRI.

So this is a good example of what an MRI can tell you – if you know the problem is in the foot, this is a very good way to see exactly what is going on.

As for doing other body parts, Tiramit, it’s a question of placing – right now the magnet can move up to about hock level (or above the knee in front), but if they had a table they could knock the horse out completely and do any part of the body, I think. Washington State can do this now, not sure about other MRI locations.

[Bea]

Tiramit, fantastic idea! At the moment I can only think of things I’d like to know more about. Besides the ones you listed – love to know more about MRIs for feet – I would add treadmill tests and sacrum injections, and think LH’s freezing machine should be on this thread.

[ColoredGrey]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by LightRanch:
ColoredGrey, that bill for the bone scan is astronomical! My horse had bone scan done a month ago at Las Colinas in TX. She was there for two nights, had the bone scan done, an ultrasound and multiple x-rays of the fetlock after discovering the problem area, two rounds of perfusion therapy on her fetlock and a box of Adequan for a little over $1400. <HR></BLOCKQUOTE>

LightRanch,Yes it was costly. I am also learning from other people that it should not have been. I guess in my area you could get away with charging so much. It is unfortunate. I will be more aware in the future to have the total bill told to me up front. But regardless, I would never base my decision strictly on how much it would cost to help my horse. (I would sell my soul if it would help him be well)It is just sad that they can take advantage of you.

[Tiramit]

Good ideas! We can add more as we think of them.

Here’s another, more basic technique:

Flex Tests:

What is it? A quick method detecting lamenesses by stressing joints for a few minutes (someone holds the leg up high and tight, thereby stressing the joints) then asks the horse to trot off on level, firm ground. Usually the first step (after initial observation) in the lameness search. Often part of a pre-purchase exam.

How much is it? The cost is usually part of the vet’s evaluation fee, so no additional charge.

Reliable? Somewhat. It can’t catch everything, but will show the more obvious lamenesses. Some otherwise sound horses will “fail” a flex-test. Often followed by a vet’s suggestion to x-ray a joint or joints in a leg.

[Dune]

This is weird, some of the posts are missing…what happened?

[ColoredGrey]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by Dune:
<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by Tiramit:

Bone scan (Nuclear Scintigraphy)

What is it? A process of injecting a horse with a radioactive / dye combination shot that results in a color-coded photo displaying injuries to the skeleton. The body is color coded by “activity”, thereby showing hot points where the horse has pain or discomfort. Different sections of the horse can be imaged - front half, back half, just the legs, etc.

What is done? The horse is injected iv with dye that attaches itself to all active bone cells and a radioactive compound. The drugs move through the blood stream and show skeletal damage and injury. Highly active bone will be more radioactive.

It’s a slow procedure, taking up to a couple of hours for certain images. The horse will be slightly radioactive for up to 48 hours after the procedure.

Cost? Anywhere from $900 - 2500. <HR></BLOCKQUOTE>

Just wanted to add that a bone scan also has a “soft tissue phase” that will show hot spots in areas like ligaments, suspensories, etc. not just the bones. This is good for diagnosing those hard to pinpoint lamenesses. Then normally what would happen is the vets would follow up with an ultrasound of the area in question. If during the bone phase, they find a hot spot, they would then follow up with an x-ray. If the x-ray doesn’t show up with anything, but an injury or abnormality is still highly suspected you would then follow up (depending on the body part) with an MRI or CT. I’d love to hear more from someone who has done that. So the nuclear scan a tool that leads them in a particular direction, rather than something like an u/s or an x-ray that would tell you exactly (hopefully) what is going on. Regarding the “slightly radioactive” part, even though when humans have this test they are sent home right away, govermental laws usually require that the horse has to be kept at least overnight and the manure disposed off as hazardous waste. You are also not allowed to visit with your horsie until he/she is ready for pick-up. So be ready to say your goodbyes for 24-48 hours when you pull up to the clinic. <HR></BLOCKQUOTE>

THOUGHT I WOULD SHARE MY STORY ON THIS TOPIC
I have had a scan done on my guy, even though we pretty much new where the problem might be( in the foot) we wanted to rule out anything that might be secondary.So off we went to the “specialist” The cost was close to $5,000. The scan it’s self may be $2,500. but by the time the vet gets finished with adding up all the rest…let’s see he charged us for hospitalization,soundness exams (one everyday for 3 days) catheters,tranqulizer,the removal of the catheter, blocks,x-rays anti-inflammatory,antibiotic,bandage, and God only knows what else… Oh wait I forgot to mention $80.00 to fill out the report! We tallied up to $5,000.
Bottom line…Yes, he confrimed we have a problem in the foot…GEEZ thanks Doc.
The scan still was not able to tell us what it was. It is not a bone issue, his bones in the foot are fine. But I knew that before the scan. All the xrays taken by MY vet showed that. I was missed led to believe that the scan could give us an answer to exactly what the problem was. Instead it ruled out what it was not( bone)
If I had known this I would have saved my money and went in search of an MRI.Basically my advice is to any horse owner. If you are able to determine with your own vet the location of the lameness and feel that it maybe a soft tissue problem (especially in the foot) please research the advantages of both Scan and MRI.See what will help you get your answer.
I am amazed that with all the technology in the world today, we are limited when it comes to our horses. Thank goodness more and more medical centers are starting to change that.

[Tiramit]

Sure thing - I updated my previous post.

[Lord_Helpus]

Great idea, Tiramit. Hopefully, it can be stickied to the top so it is available for everyone to use and add on to.

How 'bout we also provide links to the different threads that go into detail on the pro’s and con’s of each treatment to really help people find all the discussions on each topic?

It would also be nice to have people chime in with where each test can be performed, as far as they know, in case someone wanted to pursue a certain test near where they lived.

For instance, I was quite surprised to find out that none of the vet hospitals in Lexington, Ky have put in a MRI (yet), although there is a talk and one may be available in the near future. The closest MRI right now is in Va.

In fact, Rood and Riddle is just now building a new wing for an in ground tread mill for diagnostic purposes.

Rood and Riddle does offer nuclear scanning – a full body scan is approximately $1200 - $1500.

Lower limb ultra sound is $150

Shock wave treatment is $300/session.

The new carbon dioxide (CO2) treatment for freezing (taking down to zero degrees centigrade) hot splints and recent soft tissue injuries is $40/session with minimum of 7 - 10 sessions recommended. More detail on this procedure can be found here.

[Bea]

Dune, are you thinking of the MRI thread? By the way, if you’re interested in % of horses who are diagnosed with problems with MRI, there’s a good article on thehorse.com that gives numbers, doesn’t address that aspect just gives numbers. Or I could link you to a study on the ivis website that does the same thing. Mentioned numbers but doesn’t discuss follow-up.

[LightRanch]

ColoredGrey, that bill for the bone scan is astronomical! My horse had bone scan done a month ago at Las Colinas in TX. She was there for two nights, had the bone scan done, an ultrasound and multiple x-rays of the fetlock after discovering the problem area, two rounds of perfusion therapy on her fetlock and a box of Adequan for a little over $1400.

[Tiramit]

Allergy testing in horses:

What does it involve? The horse is tranquilized, and a series of shots each containing a different suspected allergen is injected under the skin of the neck (can be up to 75 shots). The shots are spaced out and skin reactions (bumps and swelling) are evaluated on a class scale by size. Readings are taken at 15 and 30 minute marks, then again at 4 hours and lastly at 24 hours from the initial injection time. Vets may also pull any scabs from the body and send them off for additional testing.

Based on the reactions, a serum is ordered with a maximum of 15 allergens in it (multiple serums can be given). The horse’s response to the serum is also evaluated to ensure the appropriate mix of allergens. The horse may be re-tested after time.

What does it cost? The test alone is about $250 - 400.

[DMK]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by Tiramit:
Allergy testing in horses:

What does it involve? The horse is tranquilized, and a series of shots each containing a different suspected allergen is injected under the skin of the neck <HR></BLOCKQUOTE>

But you can also get an allergy test done through a blood test - cost $150 (but this was several years ago, so it’s probably more now).

Subsequent desensitization serum based on specific profile of horse: $70/vial. You use three vials over the course of 3 months (they are in gradually increasing concentration - you start out with frequent shots/low concentration and move up to less frequent administration/higher concentration) . Then maintenence vials last about 5-6 months. And you learn to give SQ shots in order to get through the first 3 months or you will go broke paying for vet visits!

[welshcob]

Great idea!!

EPSM Muscle Biopsy

A muscle sample is taken and analysed for Equine Polysaccharide Storage Myopathy. This is a muscle disease, common across the breeds, that results in a horse not being able to utilize carbohydrates as energy in the muscle. A horse testing positive should be on a fat-supplemented diet. Horses with EPSM may show a variety of hind-end lameness, lack of energy, weight loss or muscle atrophy among other problems.

Muscle sample may be taken by your vet at the clinic or your facility. Labs that I know of are Oregon State University and Cornell, I’m sure there are many others.

Cost $200-400 – I don’t have my final bill yet…

From my reading only a very few horses would be in a gray area. They either show muscle distinctions or not, and the “treatment” is a low cost dietary adjustment.

A very good diagnostic tool for that unexplained lack of power, mysterious not-quite-right in the hind-end. I am very glad I did my horse. He may have more problems but I know I HAVE to provide a high fat diet if I want him to become stronger.

[Dune]

Just bumping this to see what the vets found, I turned down having this done and I’d like to see what we might’ve missed and how it helped you with a plan. Is there a post that tells us what you’ve gone through up to this point so I can get caught up?