Cervical remodeling, SI pain, RF lameness, shoulder pain... pull me out of the rabbit hole

[the_rook]

The bute trial improved my mare quite a bit. Day 2 my friend came out to help rule out the “is it me” question - ie does my training suck (jury is still out)? We worked on going forward and just ignoring the ugly head and neck/falling in shoulder thing and mare eventually relaxed. She seemed to work more and more out of it as we went on and was willing to relax sooner. We actually worked her quite a while off and on, talking, swapping saddles and riders, and mare didn’t get worse. However I did see some kind of patella slipping issue a few times on the video my friend took, trot to walk transition, right hind. Day 3 was repeatable, relaxed and forward, with less ugly neck twisting and willing to engage longer.

Rode again with no bute about a week later. First day immediately at the trot I could hear mare dragging her hind toes. On bute she was picking them up. Left seemed worse, but dragged both at the trot. She felt relaxed mentally, but body stiffer, not as willing to round up and with less impulsion, a little bit like she was trailing out in the hind. Doesn’t feel lame. Videoed a little, showed my friend. Friend thought her right hind moved slightly weird and said she for sure wasn’t dragging her toes when we worked together.

Next day rode earlier in the morning (in case she was sluggish the day before as it was warm) and didn’t lunge first to see if we could get more forward momentum. Still dragging toes, maybe less though. Felt pretty good at first, had good energy, and was willing to work. After about ~20 min alternating between walk and trot it went down hill. She stopped wanting to go forward, started doing the neck thing more in both directions, and got dull feeling. I had to basically goad her into the canter (it was a very ugly transition both ways but I wanted to see if she could canter). The canter itself seemed fine once we were going.

Thoughts:

I started thinking about the RH and the stifle. I read that hind lameness can cause front lameness on the same side, whereas often front lameness will cause diagonal pair lameness in the hinds (if that makes sense) - and we first treated the RF, but were also investigating RH. Originally my trainer thought RH high up. Mare also had off and on right side SI pain, flexed mildly positive RH hock at two different vets, but was sound on it elsewhere during the workups. So then I stared at my mare’s legs, the videos my friend took, videos from earlier in the year, and photos I have of her, and she definitely has less developed muscles on her RH - the bicep muscles specifically - going back a couple years. And now I see the RH patella catching thing on video, and just a bit of a delay in picking up her RF as the RH lands. Interesting.

I’ve also been hyperaware of everything she does and have added a few things to the “maybe it’s neuro” list: swings right hind wider when backing and turning on a small circle. Eats wet grain weird. Slightly spookier at noises. Possible loss of tail tone since spring this year? I didn’t see any tail wringing or swishing in the videos my friend took last week despite her looking grumpy sometimes as I ask her to go forward.

So, I’ve mainly been waiting to hear back from the vet about what to do next, with two camps of thought –

Physical possibilities camp: Soft tissue injury in stifle, hip, pelvis, area etc. Injury that damaged the nerves to this area that is causing muscle wastage and eventually patella slip. I have read that intermittent patella fixation is painful. Maybe that contributes to her lack of willingness to go forward, but then seems fine once she’s going.

Neuro possibilities camp: EPM, PSSM2, cervical something or other, or other neuro thing that we probably won’t be able to diagnose. Pulled blood for EPM on Friday… should hear Monday (hopefully). Other things get increasingly harder to figure out.

The key is somewhere in the right hind, and whether it’s physical or neurological I am not sure. But as my friend says, two things can be true.

[Junebuggie]

I would really recommend looking into PSSM2/MFM. My mare was just diagnosed after almost a year of chasing down lameness…bone scan, multiple MRI’s, x-rays, US and everything in between. Your horse sounds very similar to how my mare presented, although her lameness was primarily up front. She’s been on the MFM diet now for several weeks and is looking better than she has since this all began.

edited to add…hang in there, this kind of thing is so difficult and hard.

[IPEsq]

I think with the positive response to Bute and subsequent regression off Bute that I would put orthopedic pain higher on the list than neuro at this point. Compensatory patterns due to pain could also explain the muscle changes and weakness.

[the_rook]

I think this does make sense, and I’m guessing stall rest for the RF was not what the RH needed (ie stifle slipping issues - which I know are better on TO). I forgot to add I gave her 2g of bute before the last farrier visit and she did not sit back at all which was a relief to me. Hopefully that is also repeatable.

[the_rook]

Thank you for the kind words and I’m glad your mare has shown improvement on a changed diet! That must feel wonderful. PSSM2 is still on my list, especially due to her breeding and the muscle tremors, and I think we should probably try and rule it in or out going forward.

[the_rook]

EPM titer negative… no exposure. Not any closer but I guess I’ve been able to rule one thing completely out

[2tempe]

Did you get a diagnosis from New Bolton?
I’m in a similar rabbit hole, after a trip to Ocala clinic, for declining performance, difficulty/discomfort in canter, random lameness and slow recovery from work. Went from a dozen lovely 1x changes to essentially unable to do 4x just as one example.
Our conclusion there: Mild neuro signs. Had old films of neck, vet did ultrasound and expressed some concern re c6-c7 malformation.
Basic bloodwork fine, ruled out PSSM and EPM and Lyme. Vet recommended CT scan to look for spinal compression and neuro vet said that with malformation the muscles etc that tie into that area can be affected because they do not attach properly.
I have sucked up the $ issue and scheduled the CT because I just have no idea what to do with the horse now. And he has days where he seems noticeably uncomfortable.

[ndirish07]

Reading all this I feel like I read a story about my two horses combined. One has a history of bilateral hind suspensory injuries (rehabbed one… did the other 3 years later). And the draft cross has PSSM that’s well managed. The first descriptor about the lameness and shuffling, lead swapping, etc., and being positive on the RH hock make me think proximal suspensory. I’d ultrasound that… for a couple hundred bucks you’ll get decent bang for your buck.

Then I’d test for PSSM. It’s a hair sample and it wasn’t cost associated with it. My vet tested for type 2 since the test is just the hair test and not the muscle biopsy. Foxhunter needs to be in regular work, 12% or less NSC, and added two pumps of oil to his grain. He hunts first field over serious hills and will pass TBs (for a short while). He’s only had 2 tie up episodes post diagnosis and that’s when I didn’t muzzle him early enough. Every horse is different, of course, but I haven’t found PSSM2 to be the all limiting factor google would lead you to believe.

So sorry you’re dealing with this and have no clear answer. Horses can be such heart and wallet breakers!

Edited to add: Oh and my fox hunter will trip up front and act weird and shuffly if he’s not on a 5 week trim cycle. My old farrier kept their toes long. When eventer went to FL this winter I had a great farrier do him down there I learned a lot and how while their feet weren’t terrible it wasn’t helping either horse’s performance…so now I switched to that farrier full time and pay an ungodly cost I don’t talk about but both horses’ feet look immaculate and no one trips…and with the eventer and his soft tissue history I’m willing to pay Michelangelo… I mean my farrier… every 5 weeks because I decided it’s cheaper in the long run to have a sound horse than a very expensive young pasture ornament.

[SBrentnall]

I just went through this with my horse. Similar weird subtle issues over the last year or so, then a sudden onset neuro episode 2 weeks ago. Did CT last week, and came back with a diagnosis of ECVM. I’m devastated - at just 14, he’s going to have to be retired.

You can bet every horse I vet check from now on will include the special x-ray to see the C6/C7 malformation, as well as regular rads.

[2tempe]

I think this is what we will find…Mine is 10, was about to do Intermediare 2 early 2023 and oh-so-close to the GP. Also devastated. He was originally going to be my ride, but I have back issues, less secure in the saddle and he has had some spooky events. But my trainer was doing a great job with him. I have an older rock solid horse (thankfully physically and mentally), so I am riding at least. UGH horses suck sometimes…

[the_rook]

I haven’t heard back from my vet yet about the RH, but that’s pretty much what I was hoping to do - ultrasound the area and see if anything looks funky. I am getting kind of frustrated because she presents so mildly lame during an exam (the obvious behavior really only happens under saddle) that the vet seems to be not overly interested. Did your suspensory horse suddenly go lame or was it more of an off and on chronic thing first? Did it return to work after both of the rehabs? What was your rehab protocol?

As far as PSSM2 - I read the available genetic testing is unreliable. Did they maybe do PSSM1? PSSM1 is easily determined by a hair sample and PSSM2 standard is biopsy from what I’ve been told. Mine is n/n for PSSM1 (we did hair test last year for the muscle tremors), but I have been considering testing for type 2 and doing the biopsy. We haven’t had any tie ups thankfully, and I keep both the horses NSC as low as I can but I do feed local grass hay because she won’t tolerate the low carb orchard.

I think I shorter trim cycle could be beneficial and I have seen a few people mention that, so definitely something to consider. Thank you for sharing that!

[the_rook]

Keep us posted on your boy

[SBrentnall]

I’m so, so sorry. It’s just the worst. And even after 50 years with horses, I didn’t know to check for it during a PPE!

[2tempe]

actually I had neck xrays when I bought the horse in 2020. They were read as unremarkable, even from the vet in Ocala when I had him there last month. But there have been changes since then, and the ultrasound got what I think was a better view; not 100% but…

[IPEsq]

Why not ask to ride the horse for the vet?

[the_rook]

I did originally, but he steered me away from it and said it was really only helpful if they couldn’t find anything in the exam. So when we found the cervical remodeling, we thought that was “the thing” and stopped there based on her behavior (palpating sore at base of neck + what I told him she does under saddle).

I finally talked to my vet this afternoon, and he asked me to ride 5 days a week for two weeks then come in and ultrasound the RH. He wanted me to pay attention to what things she tolerated and what she did not. I actually had a pretty pleasant ride today. Walked her super forward and asked for some flexing (haunches in, leg yield) before trotting. I made sure to not trot too much (since it’s her main source of discomfort) and then cantered. Left lead canter I think I can feel the RH being short, the stride doesn’t quite match the right lead. I do wonder if maybe the neck injections actually did something, because her weird neck craning thing seems to be mellowing out a touch.

[SBrentnall]

I also had full neck and back x-rays. But apparently, there’s only one angle where you can see the C6/C7 malformation, and it’s not a typical shot when they do neck rads.

This article explains how to take the films: https://thehorsesback.com/c6-xray/

[ndirish07]

Eventer went suddenly lame but there were several times in the months before where I couldn’t quite explain what I felt but he jogged out sound. the first one the ultrasound showed evidence of both recent trauma and chronicity. The second one was only inflammation that never resolved despite rest/light hacking/small Paddock turnout and became chronic without any tears or lesions thankfully. Retuned to work after the first one and increased work load. We’re just cleared to trot now on round two. Vets anticipate full return to work. His rehab was very detailed and slow. Second time I added small medical paddock turnout a week post op and the first time I waited 30 days and strictly followed the regimen but I know the horse better this go round. Hand walking starting with 5 min twice a day. Busking each week. Once I get to 15 min I start tack walking. Walking increases 5 min a week until 45 minutes. Rescan. Then add trot starting at 2-3 minutes each week building to 20 minutes before rescan and add canter which will be 2-3 minutes building like the trot. Even though he’ll be cleared for full return to work I personally don’t jump soft tissue rehabs until a year post op/post injury.

You’re right-other horse is Type 1. My former trainers TB had type 2. She had to soak his hay and made sure to turn him out after dark when grass sugars lowered.

[the_rook]

Thank you for the information on your rehab, I’m definitely interested to see if we see anything on ultrasound. If there is an issue, I believe mine will be a chronic one. Though not ruling out that there could be two things going on even if we do find something on u/s (PSSM2). If we end up with a suspensory issue I will for sure compare notes with what you did. After rehabbing for RF, I would hope to not do stall rest again and would rather just individual turnout (instead of with my other mare). She’s very calm and I think the lack of movement for months was not helpful for her body.

Just to clarify, what procedure did they do? I hope this rehab continues to go well for you!

[ndirish07]

He’s had the same series on both hinds now and sadly it wasn’t a buy one get one : a fasciotomy on the suspensory, PRP (this second time I did prostride), 5 shockwaves each, and then class IV laser. I really credit the laser—this last time I didn’t do it early on and he still had inflammation and swelling. Well if it didn’t go down completely by the 4th laser session—I hate that it works so well because it’s rather pricey per session.