DSLD "diagnosis" in young, lame horse -- UPDATE post 130, he's gone

[Libby2563]

Very long story but my lovely young Hanoverian, who turns 5 in a couple weeks and was supposed to be my next GP dressage horse, was just “diagnosed” with DSLD by nuchal ligament biopsy.

“Diagnosed” is in quotes because I am not convinced this test is all that solid. You can see my post on the DSLD in warmbloods thread for details on that (https://www.chronofhorse.com/forum/f…-crosses/page6). The short version is that experienced vets disagree on its value, especially the value of a “positive” result (which isn’t even called “positive” actually, it’s more like “consistent with” or in my case “suggestive of”). There has never been a peer-reviewed study of this procedure even though it’s been around for at least a decade. I did it because it was relatively inexpensive and I thought that negative result would provide peace of mind whereas a “positive” result would be a gamechanger. Now though I’m not sure how much stock to put in it. So part of my problem is that it’s not clear to me how certain this diagnosis is.

Part two is that the horse is significantly lame and has had all recommended diagnostics, short of an MRI. He has been 3-3.5/5 lame on the LF since mid-October, and also had a bilateral hind neurectomy for proximal suspensory desmitis in December. The LF lameness blocks to the heel. X-rays of the front feet show osteoarthritis of the LF coffin joint (concerning in a horse his age), mild bilateral navicular bone changes (eh, lots of horses have weird navicular findings), and coffin wing fractures of both coffin bones (considered an incidental finding). We did try injecting the LF coffin joint but there was no lasting improvement, if any at all.

It’s now 4 months post-neurectomy and while the hind end is better (not 100%), the LF is still 3 or 3.5/5 lame. I have now seen four very experienced lameness specialists and it is clear that the next diagnostic step is an MRI of the front feet. They don’t all recommend it though. One of the vets would do it on his horse because he’d want answers, two of the vets wouldn’t put any more money into him, and one of them didn’t offer a strong recommendation either way. He is not insured (kicking myself for that right now) so the $3k MRI would be out of pocket. I can afford it and wouldn’t hesitate to spend that if the LF were his only problem, but combined with the hind end issues and the possible DSLD, I am not sure it makes sense.

The “hind end issues” are as follows: all of the vets concur to varying degrees that he will never be a performance horse due to his hind end conformation and the fact that he was already lame enough behind to have an arguably unsuccessful neurectomy at the age of 4, before he was even working hard. So no matter how much money I pour into his LF, they think he is unlikely to be sound behind. I have had horses beat the odds before so in my rainbow and butterfly moments pre-DSLD “diagnosis” I hoped that he could be a lovely trail and lower level dressage horse. That is not what I want for myself but perhaps I could find a free lease situation through my trainer or other connections (giving up ownership of a horse with such limitations makes me uncomfortable, as I worry he’d end up in a bad place, but I might consider it if I knew the person and felt I could keep track of him). He’s a lovely mover with the most amazing brain in the world who is very safe, fun, and comfortable to ride so at least he has that going for him, but it’s also part of what makes this so shitty.

The recent DSLD “diagnosis” threw a wrench in my idea to try to make him sound for lower levels … perhaps it is just time to give up?

I think my options are:

1. Shell out for the MRI. At least then I will have a diagnosis. If he has a degenerative disease process, I can give up on anything but supportive care. If he has a traumatic injury that could heal, I can treat that within reason and see how the hind end is then.

2. Turn him out for 6-12 months and hope he improves. The problem with this is that he has only gotten worse with rest/turnout over the last 6 months (from subtle lameness to distinct head-bob on LF), and 6-12 months of board/care at home or elsewhere will cost at least as much as an MRI, and I still won’t have an actual diagnosis. (I don’t have enough land for 24/7 turnout on grass at home.)

3. Give up and send him to a retirement home. It won’t cost much if any less than keeping him at home. I won’t be able to afford a riding horse until he dies or gets so painful from the DSLD that he needs to be put down (I already have one retired horse, my 22-year-old who’s been mine since he was 4 and certainly earned a home for life). If he does have DSLD, I’m worried about not being able to monitor the progression of his condition from afar.

4. Give up and euthanize him. The DSLD diagnosis makes this more of an option but I still think it’s premature when he’s happy and getting around okay. Yes, I do know some horses live a long time with DSLD (in various degrees of pain, I’m sure) but since he is already lame I don’t think he has very good prospects even with special shoeing, etc. I’m aware of the DSLD Yahoo group but skeptical of the Chinese herbs protocol.

5. Give up and donate him for research. My trainer and one of the vets mentioned it but this literally makes me ill. He is an “innocent” with a puppy dog personality who has had nothing but love and good care, and I can’t stand the thought of him being poked and prodded until the end of his days, even for a good cause. If he had a clear case of DSLD and someone reputable wanted to take him for research on that, I might be more inclined.

Thanks for reading. WWYD?

[Jealoushe]

My personal opinion is option 4. There is no guaranteeing a safe home, and with being a possibly fancy horse, someone out there will most likely try to ride him anyways. You have spent a lot of time and money on diagnosis and the horse is not remotely sound.

Sorry this is happening for you.

[IPEsq]

Just curious…what line is he? (perhaps that is in the other thread?) What are the issues in his hind leg conformation?

Friend of mine has a young Hanoverian. He has an S name but I’m not sure of the sire line. Anyway, poor guy is super sweet but has never really been sound. He’s big and about the age as mine (so maybe 7 or 8 now, and I think she had the horse since he was 4 or 5?) and we did a lot of commiserating over vet calls together. Anyway, he is lame in both fronts, with one being worse than the other. Owner did do MRI and even surgery in the front feet. There were navicular changes, coffin joint changes, and suspected DDFT problems. But apparently, when they got in there, the soft tissue didn’t look all that bad.

They tried various different shoes and wedges and pads. He also seemed off in the hocks mildly but it was suspected it was really proximal suspensories. He’s kind of straight in the hocks in conformation, at least compared to my tall Hanoverian. But he’s kind of short in the loin, and he tended to stand camped out, so that may have skewed what his hind end really looked like. They injected hocks and injected the navicular bursa and injected coffin joints. And nothing seemed to work. He is not riding sound at all. Even at the walk, he is not tolerant of added rider weight, although lameness is probably only a 2 in the worst front. I need to check on horse’s current status, but he should be in the middle of trying a year in pasture.

With your story and all things considered, I wonder if these two cases are related and if the other horse has a systemic problem. The vets were stumped why with all that they’ve done for the front feet there has been basically no improvement. It doesn’t make sense to them based on what things look like. It’s hard when they seem happy enough just hanging out being a horse, but I also live in an expensive area. Owner of the horse in this story has a small piece of land but it wasn’t enough for the horse to do well there, so she is still boarding. It is an extremely hard decision. I’m not sure what I would do. And that’s coming from someone who has almost thrown in the towel on her own horse a few times now.

[Libby2563]

@IPEsq

Just curious…what line is he? (perhaps that is in the other thread?) What are the issues in his hind leg conformation?

Oops, should have included that. Both pieces of info are in other threads but I didn’t mean to make people hunt!

He is by Bugatti out of a Del Piero mare.

His hind leg conformation issue is long pasterns. Vets have described them as “saggy.” They aren’t dropped in the sense that they used to be upright and are now dropping (what you see with DSLD horses as they age), but they are dropped relative to ideal conformation. They have been this way since I bought him as a yearling (yes, he passed a PPE). He doesn’t have especially straight hocks, which tends to go along with this, but all vets agree that those pasterns will limit his soundness.

It doesn’t help that he is quite large and has a pretty heavy build. I chose him as a weanling and he was expected to end up around 16.2-16.3 but he is well over 17 hands and will probably still grow some more.

He never took a lame step in his life until all this started in October. I started him myself and was having so much fun with him.

I’m sorry to hear about your friend’s situation. That is kind of what I am hoping to avoid…years of trying this and that to no effect.

[drafting_dots]

Here is what I would do: #3 for a year, reassess, then continue with #3 or move to #4.

Unless you are in a financial position where spending $3k all at once doesn’t bother you at all (like, honestly doesn’t), then I would do #1 first.

[drafting_dots]

@Libby2563

That is kind of what I am hoping to avoid…years of trying this and that to no effect.

I’m here too right now. We’re trying to figure out if my horse has diag A or diag B. If he does not have diag B, then the next step for diag A is MRI expensive. I actually do have insurance, however, my policy grace period ends in a month and he is essentially only partially covered (mortality has run out). Retiring him for a year would cost more than the test for a definitive answer, and after that year he would have no insurance. Diag A recommendation would likely be euthanize. If it’s not diag A, then we’re at square one entirely-- no answers and an unrideable horse.

My initial instinct to your question was to answer #3, and #4 after a year if no improvement. But typing out my own experience, I now almost lean towards doing the MRI. The question I would want to ask though is, what will the MRI tell you that would force you to make a decision either way, and how likely is it that the MRI will provide that information? If less likely, I might still do #3 and #4. Worst case, you spend only a small bit more (board + euth) than you would have with the MRI and have some conclusion that your horse will likely not improve. Best case, you have a sound horse.

MRI
answer
potential loss – $3k; $treatment or $euth; no time lost
no answer
potential loss – $3k; $retirement or $euth; no time lost
No MRI

[drafting_dots]

@Libby2563

That is kind of what I am hoping to avoid…years of trying this and that to no effect.

I’m here too right now. We’re trying to figure out if my horse has diag A or diag B. If he does not have diag B, then the next step for diag A is MRI expensive. I actually do have insurance, however, my policy grace period ends in a month and he is essentially only partially covered (mortality has run out). Retiring him for a year would cost more than the test for a definitive answer, and after that year he would have no insurance. Diag A recommendation would likely be euthanize. If it’s not diag A, then we’re at square one entirely-- no answers and an unrideable horse.

My initial instinct to your question was to answer #3, and #4 after a year if no improvement. But typing out my own experience, I now almost lean towards doing the MRI. The question I would want to ask though is, what will the MRI tell you that would force you to make a decision either way, and how likely is it that the MRI will provide that information? If less likely, I might still do #3 and #4. Worst case, you spend only a small bit more (board + euth) than you would have with the MRI and have some conclusion that your horse will likely not improve. Best case, you have a sound horse.

I’ve been making flowcharts for myself to lay out all the options. What’s more important to you-- time, money?

MRI
answer
potential loss – $3k; $treatment or $euth; no time lost
chance for recovery
no answer
potential loss – $3k; $retirement (see below) or $euth; no time lost

No MRI
retire
potential loss – $retirement, year+ time lost
chance for recovery
euth
potential loss – $euth; no time lost
retire + euth
potential loss – $retirement, $euth, year+ time lost

[joiedevie99]

So sorry to hear! Horses are heartbreaking.

With three soft tissue injuries (two suspensories plus what I’m guessing might be a DDFT or ligament in the foot) (plus some other issues) before serious work started, I wouldn’t hold out much hope regardless of test results.

You could do the MRI and find the spot of the injury - which may allow you to put stem cells or PRP in. But are you going to do that every time a new soft tissue injury pops up? I wouldn’t be surprised to see a compensation injury in the opposite foreleg before he recovers from the current one if he is 3/5 on an ongoing basis.

I’d turn him out for a year or two with NSAIDS on board until he isn’t comfortable anymore.

[halt]

I chimed in on the other thread, but just wanted to commiserate again and say I am so sorry you are going through this. It sounds like a very difficult situation ahead.

I agree that, at such an early age, the prognosis for long-term soundness in an athletic endeavor is poor. That’s not to say he wouldn’t be manageably sound for another job, like maybe trails as you mentioned.

Before I considered option #4, I would try a real case of Dr Green… as in… fully outside, 24/7, for at least half the year. It is not a Magickal Miracle Maker, but sometimes with some systemic issues, compensatory issues I’ve seen, horses have come back from Dr Green fairly well.

However, given how much money you’ve already invested in him, I think asking for that might be unfair as it requires a substantial amount of money in board with no use of the horse… so I understand your decision, either way.

Either way, jingling for you and your boy.

[Libby2563]

I reached out to the vet who did the neurectomy and biopsy for guidance and he said, “I am not surprised. I would pretty much disregard a positive result (only a negative has value).” (Underlining his.) He did not recommend the biopsy for this reason but I guess some things we have to learn ourselves the hard way.

I am still left with the problem of a young horse with suboptimal conformation who is lame on multiple limbs, but…what the hell kind of test is this?

[FreshAir]

Well I just threw some money at an MRI myself $3500 - but it gave me piece of mind that there wasn’t a major injury. However, as you have other issues and are looking at a project that probably won’t turn out the way you want (a reliably sound horse), I would consider a peaceful euthanasia. It sounds like you have investigated all the ways to get the horse sound and the answer is that he won’t. I wouldn’t send him to a retirement home. I think you have the best eye for him and someone else might not. So you could go down the middle, turnout, in your care for six months and if that doesn’t work, give him a great last day. Sorry this sucks - no way to get around it…but you have served him very well.

[Angela_Freda]

Yo had DSLD/ESPA.

I would go with a combo of option 3 and 4… retirement for a while, with you or if you can find a barn that can manage a DSLD/ESPA horse- with nice terrain, stall for periods of rest, a farrier who will work with you whether you go barefoot or shoe him with lifts**, and nutritional support- IR diet- that suits as well as includes appropriate pain management… and then euth when he’s not comfortable. It is basically what I did, and Yo got 6 years out of it and he did enjoy them.
That is a lot to trust someone else to do if you can’t have him at home with you. I was lucky that the retirement farm Yo went to was the example of how to do it all right.

**I had a great farrier who shod him carefully, slowly, fully aware of his deficits and considerate of the time and care needed to just get him trimmed… and who really thought through what our goal was. He came up with steel shoes with several lift/wedge pads to lift the heel. Initially we did an Aluminum shoe that had a lift, but it could not be reset and was going to be $$$$… the steel shoe, with a rolled toe, and those pads was the compromise of getting him the heel lift he needed to be comfortable, while being less costly because they could be reset.

I agree with you on the DSLD group and their Chinese herbs. The herbs might work on some horses [ though I find their grasp of science to not be the firmest in that group and it troubles me that the person pushing them is the one selling them…], but with horses who have other issues as well as DSLD/ESPA [ Yo had high ringbone, could tie-up, etc ] I think you have to treat the whole animal and the supplements and meds that the herbs contraindicate made that impossible to do.

[Laurierace]

I actually love donating a horse like this to a good vet school like New Bolton. The horses are treated with nothing but kindness and get to live their lives like a horse to the point their disease allows. When the time comes they are euthanized with compassion and hopefully teach the researchers something that can prevent someone else from going through your heartbreak.

[Libby2563]

Thank you all for the thoughts.

This is what is swirling around in my head this morning. (Sometimes I wonder where the line is between hope and delusion.)

I heard from the other two vets whose opinions I most respect yesterday. One would like to see the histology report so she can compare it to the others she has seen. Some of those cases were confirmed by necropsy so that sounds like a useful idea to me. The other one must have less familiarity with the test because he thought it provided a clear negative or positive. He suggested seeking a second opinion from another pathologist who ideally would NOT consider the horse’s age and lameness in the interpretation, just the sample itself. That sounds fine to me too.

He did say that he is inclined towards a DSLD diagnosis given the histology results, saggy fetlocks, and multiple soft tissue injuries. That made sense too. However, as I think about it more, it occurred to me that we don’t even know this horse has even one soft tissue injury. The surgeon recommended neurectomies for the hind suspensories based on blocks and flexions alone. Ultrasound performed right before the surgery did not show any tears and over the phone he told me there was nothing significant, which he said was good because recovery should be shorter (meanwhile I wondered why we were doing surgery if there was nothing significant on the ultrasound, but I trusted him). The report from the brief ultrasound done right before surgery mentions “mild irregularity in the fiber patterns,” which doesn’t sound like a very strong finding. One of the vets I spoke with yesterday asked if there were hock x-rays taken before surgery, because the same block can affect the hocks as well–there were not.

We also don’t know that whatever is going on up front is soft tissue. It could be a bad bone bruise or something related to the navicular changes. When he first went lame, my regular farm vet and I both saw lameness in the LF alone, nothing behind (though we both definitely could have missed it). A few weeks passed before a specialist first saw him and also identified the LH lameness. Couldn’t the milder hind end lameness be a result of compensating for whatever happened up front? In that case he might not have any primary suspensory issues, just compensatory soreness. I am starting to feel like we went about this all the wrong way and if I could do it again I’d have focused more on the LF before even considering the neurectomy.

Granted, even if this is all true I still have a young lame horse who might not have great prospects, but a traumatic injury in one leg followed by compensatory lameness in two seems a lot less damning to me than independent lameness on three legs.

Is this line of thought hope or delusion?

[mvp]

@Laurierace

I actually love donating a horse like this to a good vet school like New Bolton. The horses are treated with nothing but kindness and get to live their lives like a horse to the point their disease allows. When the time comes they are euthanized with compassion and hopefully teach the researchers something that can prevent someone else from going through your heartbreak.

I think I might donate this horse to a school already studying DSDL.

And did I read right that he’s got some boney problems as well?

I am more willing to euthanize now than I used to be, so doing so for a young horse with so many problems would be the direction I’d go. And I’d try hard to make sure he was treated well until he left this world. That the thing I could feel good about in this situation. But this horse is also one that could teach researchers to much about these problems.

Good luck with whatever you choose.

[findeight]

My thoughts would be 3 and 4. Donating is a great option but you can’t count on a school taking him when you are ready to let him go that route. It’s something that many throw out there but few are ever able to coordinate, school either has a study of that specific condition in progress in need of subjects or doesn’t. You don’t just call them and arrange a drop off date. Don’t settle on the decision to donate unless you have a confirmed spot for him, in writing. Know a few who went down that rabbit hole, finally decided to donate but there was no room at the inn.

Going to get a little blunt with you here. What about this horse makes you think he is “happy”? He’s been 3-3.5/lame for a solid 6 months in front with coffin joint osteoarthritis and has already had two neurectomies behind just to get around…that don’t seem to have been particularly effective. And he’s 4. Are you sure he’s enjoying life despite daily pain or are you seeing what you want to see here? Horses don’t have emotions, they live in the moment. He hurts every moment, at 3/5 it’s substantial pain,

Tough one, sorry. But you are already supporting a retiree and are looking at another 5 years easy but that one is living in moments that don’t hurt. IMO Insurance often tempts us to do things because we can, not because we should. Keep in mind this young horse is going to get bigger and heavier. It’s a matter of individual ethics here, no right answer. No wrong one either for OP. What’s right or wrong for the horse?

[Stacie]

I just read on the other thread your description of your conversion with Dr Halper. Her interpretation of the biopsy is that she is as sure as she can be that your horse has the disease. Only a necropsy would be more accurate. The degree of pain and lameness at such a young age is against him.
. I’ve been in your shoes. You don’t want to.give up if there is any chance. There is no chance for this horse. None. Which is a blessing in disguise because you’ll never have to ask yourself, “what if”.
One option is to take the horse to a vet school where he is immediately euthanized so the students can do a necropsy for research. That way you dont have to wonder about his care but the vet school gets some benefit.
. Btw, the vet who did the surgery is not too be trusted. Who neuros a horse without a definitive diagnosis? Geez

[Libby2563]

@findeight

Donating is a great option but you can’t count on a school taking him when you are ready to let him go that route. It’s something that many throw out there but few are ever able to coordinate, school either has a study of that specific condition in progress in need of subjects or doesn’t.

I wondered about this myself. There certainly doesn’t seem to be much funding for DSLD studies, or we’d probably know more by now. The vet who mentioned donation said something about use as a blood donor.

@findeight

Going to get a little blunt with you here. What about this horse makes you think he is “happy”?

I understand and appreciate your reality check. This would actually be so much easier if he were unhappy or in obvious pain during daily activities! I’m watching him meander around with his buddies enjoying the spring grass right now. His walk is still huge and elastic (last vet we saw noted that there was no sign of discomfort whatsoever at the walk). He naps in the sun as much as he ever has. He has no trouble getting his hooves trimmed. He romps and broncs sometimes and only in the trot can you see lameness. He’s always the first to meet me at the gate with bright eyes and pricked ears, waiting for kisses and attention. I have a good relationship with my local vet, who is very down to earth, but I’ve actually wondered if I can even get a vet to put this horse down when he shows no real signs of suffering. It also makes me feel like I’d be euthanizing him for my own convenience rather than his benefit.

ETA: I hope I don’t come across as stubborn or argumentative. I am processing everyone’s input and finding it valuable. It’s just a really difficult decision to make at this point–which is why I asked for input! And I want to get all of my second-guessing out of the way now, rather than making a decision and regretting it later.

[findeight]

Give any vet the horses folder full of diagnostics and let them see him limp at anything out of a walk and doubt there will be any hesitation. Not talking about the possibility of DSLD either…he’s lame, he’s been lame, he’s had two unsuccessful neurectomies behind, dx OA in front coffin joint and he’s going to get bigger and heavier on soggy pasterns.

Vets sometimes say what owners want to hear and skirtthe truth to retain their loyalty. Ask them, honestly , what would they do if he were their horse.

It sounds like it might be best for you to get that MRI so you can get some peace from a clearer picture of what’s going on inside. Then turn him out. As in out out. Leave him alone at a nice retirement barn, let them handle him and assess his life situation from a neutral viewpoint. Don’t misinterpret Horse behavior for human emotion as in thinking he’s coming to the gate for kisses from you when he’s after a treat and you’ve taught him once you are there, there will be a treat to follow.

This hits close to home as I just watched somebody spend 3 years and over 25k after the Insurance capped out on a homebred that had hind suspensory problems from about 60 days after his first ride. Not my horse, don’t have details but it is a German variety WB with baaaad pasterns. Still have it out back of their place, still unusable at about age 8. DD never got the Junior Hunter this was supposed to be and the family was hit with the big C and no financial cushion since they spent it on the horse. It’s hard to watch that. Over and over.

Turning him out and leaving him alone will allow you to back away a little and give everything time to soak in and the MRI wil leave you comfortable you didn’t skip anything looking for the problem, even if it doesn’t identify anything specific. And the year will give him a shot at recovering or reveal it’s not going to happen.

[enjoytheride]

My good mare developed a very rare form of cancer in the heart not usually seen in horses that was incurable. We found this out after we donated her to a big vet school in the area. It gave me piece of mind that I stopped paying for treatment at the right time (initially we knew it was heart related but didn’t know what it was and the symptoms were baffling to several good vets) they actually wrote a few papers on it and I hope it helps horses in the future.