DSLD, Nuchal Ligament Test, Shockwave.

[Lord_Helpus]

Third try; each gets shorter… What happened to the ‘save and restore’ feature?

Goob’s has all the symptoms of DSLD. Dr Allen has suggested that he have a nuchal ligament biopsy and test to determine if he has DSLD or another issue., If it is DSLD, there are no"fixes". He just lives out in the retired horses field… If it is not DSLD, then ???

What can you all tell me about this?

Dr Allen also mentioned shockwave treatment. Q: Is it regenerative? or just palliative? I do know that it is not cheap.

What can I expect from here on? He is 6, and his current symptom is a slight toe drag at the trot. He also prefers to rest that leg and stand on the other 3.

I had really hoped that Dr Allen had a rabbit he could pull out of a hat, but it does not seem to be a realistic expectation. It is finally hitting me that Goobs will never reach his potential. Instead he will be a retired pasture pet who will outlive me.

Horses are heartbreaking…

ETA: an informative and (slightly) funny article on DSLD. Live and learn — If you are thinking of buying a horse whose pasterns are slightly dropped, either question the breeder or have more examinations/tests done. I had no idea that DSLD is hereditary, and in horses who have it, nothing can be done.
https://www.doctorramey.com/degenerative-suspensory-ligament-disease-dsld-espa/

[Libby2563]

I really sympathize. I have been worrying about DSLD with my wonderful 5-year-old too, even though the surgeon who did his suspensory neurectomy thinks it’s unlikely.

I was interested in doing the nuchal ligament biopsy too. I talked to Dr. Courtney Bolam-Bretl of Piedmont Equine in VA and she seems pretty knowledgeable on the subject. She co-authored a 2011 study on skin biopsy/enzymes in Paso Finos with DSLD (http://dx.doi.org/10.1002/jor.21332). She is willing to do the biopsy and has a contact at UGA (my emails to Dr Halper have always gotten bounced) but she doesn’t regard it as settled science. There are still no peer-reviewed studies on it. She also questioned whether it may be less conclusive in a young horse, which Goober is too I think.

I’m curious to read other people’s replies.

[IPEsq]

If you are thinking of testing for DSLD, then definitely do that before you spend money on shockwave. Shockwave (like everything else we have available now) isn’t going to “fix” DSLD.

[Lord_Helpus]

One more (unanswerable) question: I have been searching for a ‘cure’ for Goober for 11 months now. And this email from Dr Allen is the very first time I have heard “DSLD”. Why would that be? Is DSLD so rare that no vet even considered it as a possibility?

The first thought was EPSM because of the muscle wasting in his haunches. Biopsy done. “Mild indicators” so he has been treated like an ESPM horse for the last year. Then a full body nuclear scan. Then treadmill walking. Then Dr Newton with his “degenerated topline” diagnosis. Then [something else].

FINALLY, in Sep., soft tissue was considered. (so I opened up a new ‘file’ with the insurance company). Special shoeing was tried. THEN, I took him back to NC State for a lameness exam, where, he was (finally) ultrasounded – which led to an MRI. STILL no mention of DSLD. I was just told that he had suspensory damage and they could not operate. After that, I was still searching so O took it upon myself to contact Dr Allen ---- and the reply I got was the devastating diagnosis of DSLD. But with the sliver of hope that a nuchal ligament test might rule it out.

In retrospect, all the pieces fall into place with that diagnosis. But why so long to come up with it?

[Lord_Helpus]

@Lord Helpus

One more (unanswerable) question: I have been searching for a ‘cure’ for Goober for 11 months now. And this email from Dr Allen is the very first time I have heard “DSLD”. Why would that be? Is DSLD so rare that no vet even considered it as a possibility?

The first thought was EPSM because of the muscle wasting in his haunches. Biopsy done. “Mild indicators” so he has been treated like an ESPM horse for the last year. Then a full body nuclear scan. Then treadmill walking. Then Dr Newton with his “degenerated topline” diagnosis. Then [something else].

FINALLY, in Sep., soft tissue was considered. (so I opened up a new ‘file’ with the insurance company). Special shoeing was tried. THEN, I took him back to NC State for a lameness exam, where, he was (finally) ultrasounded – which led to an MRI. STILL no mention of DSLD. I was just told that he had suspensory damage and they could not operate. After that, I was still searching so I took it upon myself to contact Dr Allen ---- and the reply I got was the devastating diagnosis of DSLD. But with the sliver of hope that a nuchal ligament test might rule it out.

In retrospect, all the pieces fall into place with that diagnosis. But why so long to come up with it?

[Obsidian_Fire]

My trainer recently put down her 5 y/o WB mare due to quickly advancing DSLD. Heartbreaking, and she, like you, found out it can be hereditary.

I’m sorry.

We currently have 2 old horses at my barn with it, both of them get around just fine, neither are ridden. However, in another instance, 2 horses were retired because of it, and one day they literally took that “last step” and had to be put down immediately.

It sucks.

[JB]

@IPEsq

If you are thinking of testing for DSLD, then definitely do that before you spend money on shockwave. Shockwave (like everything else we have available now) isn’t going to “fix” DSLD.

This.

SWT might provide some temporary relief from symptoms, but not likely anything of substance, so if it is DSLD, I honestly wouldn’t do it.

Yes it is absolutely hereditary. How, we don’t know yet,but hopefully sometime in the near future someone will discover the gene(s) so we can test and start to eliminate it.

[halt]

wasn’t DSLD suggested in one of your threads about the toe-dragging?

i remember some posters called out that suspensory issue even before the vets did. am i misremembering a DSLD comment or was that a different poster’s thread?

SWT would not do much to alleviate anything if it was DSLD, so do the nuchal biopsy first. unfortunately like other posters said, there is not a cure. there are ways to manage it though. keep them shod on all 4, pay special attention to their angles and make sure they are not back-sore. previcox helps, as does keeping them in a constantly moving, full turnout arrangement. there isn’t anything you can do to prevent the progression but you can manage their pain and soreness.

DSLD is absolutely hereditary. and the heartbreaking thing is that it is fairly common in WBs - as in, when a WB comes in with a toe-drag or a history of overall body malaise it’s one of the first things i suspect… there is no excuse for horses to be bred that have family history of DSLD. if goober ends up having DSLD (and i hope to god he does not), don’t do what other WB owners and breeders are doing and quietly retire him behind the scenes… make sure you tell his breeder[s], and, if you are up to it, the registry because IMHO i am only seeing more and more DSLD as time goes by… and SOs still continue to stand their stallions that have DSLD… granted, a lot of times DSLD does not crop up until the later half of a stallion/mare’s life, so there is a genuine excuse there – that i could overlook, except even with this knowledge there are still SOs that don’t acknowledge that their stallion has the propensity to pass on this disease which is a disservice to the registries the stallions stand in, and the individual offspring that are affected by it.

[IPEsq]

I may have raised it at some point in one of the other threads. A couple of people have questioned it for my horse due to how widespread his issues are (it affects connective tissue generally—just the suspensories are what tends to make it ultimately fatal). But some of my vets, like your vet, tend to dismiss it as an old horse disease. Which we are learning isn’t the case, although by the time the fetlocks start to drop, the typical slow progression of he disease means that you’ve got an older horse by then.

Anyway, I think it’s reasonable to consider the biopsy. I think if it’s positive, then you know for sure he’s not going to come back from the suspensory injury. And it doesn’t make sense to spend the huge price tag for shockwave. If he doesn’t have it, then shockwave might be beneficial for that suspensory.

[keysfins]

@Lord Helpus , one of your posts, possibly the intended first post in this thread, ended up in the Announcements >> Events forum at the top. In that post, your formatting is a bit off but it is still readable. I think you mention an email here in Post #1 referring to a Dr. Allen? The email looks to be part of the post over in Events.
Confused? Me, too!

Also, pls check you PMs.

[DFL]

@Lord Helpus I have a Thoroughbred who has suffered from hind suspensory problems off and on since he was about 9 or 10 (he will be 18 this year). He isn’t diagnosed DSLD but rather chronic suspensory desmitis. His vets have been hesitant to do shockwave therapy because of concerns that it may cause him to overdo it or that it wouldn’t do anything at all. They don’t consider him a surgical candidate because of the risk of complete suspensory failure. Is this why the vets said Goober isn’t a candidate for surgery? I think the most helpful thing I did for my horse was going through with doing ProStride in his hind fetlocks last fall. He also gets daily Previcox but I honestly can’t tell much of a difference when he gets the Previcox.

[Pippigirl]

@DFL

@Lord Helpus I have a Thoroughbred who has suffered from hind suspensory problems off and on since he was about 9 or 10 (he will be 18 this year). He isn’t diagnosed DSLD but rather chronic suspensory desmitis. His vets have been hesitant to do shockwave therapy because of concerns that it may cause him to overdo it or that it wouldn’t do anything at all. They don’t consider him a surgical candidate because of the risk of complete suspensory failure. Is this why the vets said Goober isn’t a candidate for surgery? I think the most helpful thing I did for my horse was going through with doing ProStride in his hind fetlocks last fall. He also gets daily Previcox but I honestly can’t tell much of a difference when he gets the Previcox.

Is ProStride very expensive? Is it only available in the US?

[findeight]

LHS, I think vets missed it because horses are huge, somewhat fragile animals with a long spine, four long legs with hooves and lots of bones, muscles, nerves, ligaments and tendons. Finding the source of a vague NQR condition is very much needle in haystack, especially if there is compensatory lameness. Pain might be far worse then observed if the horse is stoic, far less if it’s a wimp. Vets might be influenced/ guided where to look by something owner told them or something they are researching and look for that to support their theory in their upcoming paper and lectures… It is a daunting task.

Its also very possible, if it is DSLD, that the degeneration was not easily seen early on but as the horse has gotten older it has progressed to the point it’s getting obvious. This stuff is a pretty new field as diagnostics improve every year and Superman would struggle to keep it with it on top of running the rest of their practice.

Dam, you have had horrible luck with your horses the last few years…I am so sorry.

[DFL]

@Pippigirl I think I paid $500 for both fetlocks. Much cheaper than IRAP or PRP alone because it is a single injection that lasts up to a year. Larger joints typically cost more as you may need one “kit” for each stifle, etc whereas one “kit” was enough for both fetlocks in my horse. I’m pretty sure it is available in most places but not all vets offer it.

[Montanas_Girl]

FYI, this condition is now known as ESPA (Equine Systemic Proteoglycan Accumulation), not DSLD. You may have more luck finding current information using that in the search term.

I feel for you. ESPA is what ultimately led me to euthanize my heart horse last fall. It is a progressive, systemic condition, and there is no treatment/cure. I can’t imagine that shockwave would have any real benefit, other than maybe temporary pain relief. NSAIDs didn’t even help my guy, although gabapentin did for quite a while - you might ask your vet about giving that a try. If you ever want to vent/swap stories/bounce ideas off someone, I’m happy to listen via PM.

[Lord_Helpus]

@DFL

@Lord Helpus I have a Thoroughbred who has suffered from hind suspensory problems off and on since he was about 9 or 10 (he will be 18 this year). He isn’t diagnosed DSLD but rather chronic suspensory desmitis. His vets have been hesitant to do shockwave therapy because of concerns that it may cause him to overdo it or that it wouldn’t do anything at all. They don’t consider him a surgical candidate because of the risk of complete suspensory failure. Is this why the vets said Goober isn’t a candidate for surgery? I think the most helpful thing I did for my horse was going through with doing ProStride in his hind fetlocks last fall. He also gets daily Previcox but I honestly can’t tell much of a difference when he gets the Previcox.

The more I think I know, the more I realize how little I know. I had started to write my understanding between DSLD and SCD. And I was right, sort of. So, instead of giving half assed information, here is an article which explains everything that a very smart layman, with incredible tenacity, might understand. It even has pictures (sort of):

http://www.vetmed.ucdavis.edu/ceh/local_resources/pdfs/Pubs-SuspBrochure-bkm-sec.pdf

[DFL]

@Lord Helpus Thank you for the article. It is definitely one of the more accessible articles about suspensory ligament injuries. So was it your horse’s DSLD diagnosis that made vets say that he couldn’t operate? Just trying to further my knowledge about what types of suspensory damage make horses ineligible for surgical intervention. Thanks and best of luck with Goobs.

[Lord_Helpus]

Here is the pertinent part of the email I got back from Dr. Allen:

Treatment with shock-wave is a great option. There is no downside to this therapy and is applicable to the affected area on both limbs. It will likely be difficult to find a surgeon, and to develop rationale for surgery at this moment if there is a possibility of degenerative suspensory ligament desmitis (DSLD). With DSLD, surgery may cause a catastrophic failure of the tendons and ligaments which is not a desirable outcome.

Just to ensure that we are on the same page,

DSLD is a progressive degenerative condition primarily affecting the branches of the suspensory ligaments. This disorder causes mild to severe lameness either bilaterally or quadrilaterally, and can occur in the absence of athletic activity. Clinical signs can range from stiffness in gait to an overt lameness. Moderate to severe pain is often evoked by palpation of the suspensory ligament branches. There is enlargement and thickening of the suspensory branches, and a positive response to distal limb fetlock flexion. Progressive hyperextension or dropping of the fetlocks is often observed. There is diffuse loss of echogenicity and poor fiber pattern noted throughout the affected portion of the ligament on ultrasound examination. The disease is progressive in nature, and there is a lack of successful treatments available. We do not know if this is what Word of Honor has, but is definitely something that we want to rule out.

To rule out DSLD, we would advise a nuchal ligament biopsy. This is a procedure that requires the removal of a small piece of the nuchal ligament, which is a large ligament that connects your horse’s poll and it’s withers. It is a minor surgery that can be carried out by your local general practitioner. A website that is a good resource is: http://www.angelfire.com/bc/curlygait/biopsy.html

The biopsy needs to be sent to Dr Jaroslava Halper at the Department of Pathology, College of Veterinary Medicine, The University of Georgia.

In summary, there is no need to bring Word of Honor in to our clinic at this time. Proceeding with shock-wave is a reasonable treatment strategy with no risk. We do strongly recommend getting a nuchal ligament biopsy to get help us further determine the likelihood of DSLD and help us strategize for the future.

[findeight]

@Lord Helpus

The more I think I know, the more I realize how little I know. I had started to write my understanding between DSLD and SCD. And I was right, sort of. So, instead of giving half assed information, here is an article which explains everything that a very smart layman, with incredible tenacity, might understand. It even has pictures (sort of):

http://www.vetmed.ucdavis.edu/ceh/local_resources/pdfs/Pubs-SuspBrochure-bkm-sec.pdf

WOW, what a great link to a complete, relatively easy to digest explanation with helpful diagrams explaining the alphabet soup of abbreviations for conditions and defining them. And nobody is trying to sell you any snake oil.

[Angela_Freda]

In my horses case the dsld/espa was exacerbated by an ulcer condition, brought on by stress. I believe in some cases an illness or stress can create the situation where latent dsld/espa is able to express, when it might not have otherwise.
I also wonder about a relationship, maybe simply comorbidity or truly related, of an ir/ppsm situation and dsld/espa.