Kissing spine and neck issues - a thread

[IPEsq]

What were the exact findings on the neck X-rays? With so much front end involvement it may not be his back at all as the main concern. Did a specialist measure the distance of the spinal canal or note any narrowing? Was just talking about this with someone this week. Comparing two cases of “wobblers” in the past month. (Quotes because compression that’s not early development isn’t exactly wobblers syndrome right?). One was a 5yo WB that had a couple questionable events, grew a lot, then became ataxic pretty quickly. The other was a 14 yo GP dressage horse who’d always been a little weird but you know, was showing at GP. Did have that freaky front end movement. Pretty suddenly had trouble just getting around. I’ve also talked on here about a horse I worked with who also got neuro at 14. He had ECVM and a LOT of arthritis. I think it was the arthritis that contributed to the impingement in his case though I never saw the report from when he went to NBC.

If it really is neck and neuro, then none of the rest of it really matters as far as management and prognosis. I’m with your vet on that. Although if his back hurts or he’s lame or his feet are long or sore, he might avoid certain behaviors due to discomfort or feeling unsafe dealing with that with sub-optimal proprioception.

[awaywego]

@Simkie

Wow, really?! For a horse? How did they want you to use it? I’m so curious!

Yes, really. 2022 for pain management related to lymphangitis recovery. The directions were 8 300 mg tablets 3x daily for 2 weeks. I didn’t do it I like NBC for a lot of stuff, but I was very unhappy with the care my horse had received that time, including “try pregabalin, we’d like to know if it works.” I wish I could remember more details. My discharge report had so many inaccuracies that it’s virtually useless. It makes me mad looking at it again now to be honest

[Simkie]

@awaywego

“try pregabalin, we’d like to know if it works.”

Yikes! Talk about using you as a guinea pig!

It was right around that time that I asked my vet about it and she said literature was sparse but what was out there said it had been shown to cause colic

[fivestrideline]

@IPEsq

If it really is neck and neuro, then none of the rest of it really matters as far as management and prognosis. I’m with your vet on that. Although if his back hurts or he’s lame or his feet are long or sore, he might avoid certain behaviors due to discomfort or feeling unsafe dealing with that with sub-optimal proprioception.

It’s so hard to tell. I think he’s a big ball of connected issues. And that’s been my hardest struggle with him for years - get one thing fixed and something else falls apart, or the “fix” for one thing actively hurts something else but both issues are also feeding into each other.

@IPEsq

What were the exact findings on the neck X-rays? With so much front end involvement it may not be his back at all as the main concern. Did a specialist measure the distance of the spinal canal or note any narrowing?

So the answer to this is basically “we aren’t sure”. The vet was supposed to send them to a specialist but just… didn’t? And long enough went with no traction that I was so overwhelmed by it all and stopped following up with them.

In the field, we couldn’t see anything glaring besides a few abnormalities in conformation. Nothing obvious like arthritis, but some places were flat instead of shaped as expected from what I recall. Nothing missing or transposed or anything waving a giant red flag. However, I did not get the ECVM rads done because my vet looked at me like I was crazy when I asked (it’s really exhausting dragging your vets to every. damn. test.).

Either way, I think an ultrasound might be more productive but only worth it if I took him to a specialist at this point. (The horse is a NIGHTMARE to haul, and with his questionable neuro stability I’m not convinced it’s worth it.)

I have learned from this that it is worth every penny to just take the horse to the vet school for anything more than a cut or colic. Saves time and money.

[VolteSomeday]

I do not intend this to sound harsh towards you whatsoever, but it does seem like it’s time for a conversation with the vet(s) that goes something like: “We have been chasing things for over 2 years, this horse is living with pain that we’re unable to consistently manage. Please stop rearranging deck chairs on the Titanic with more diagnostics. We will likely never know all the things that are wrong, but we need to treat this palliatively ASAP, and if that means a humane end, so be it.” You have spent countless hours and dollars trying to help this horse, but he still hurts. Sometimes that’s all that matters. My sincere sympathies to you, and to him.

[fivestrideline]

Yeah, I’m with you. 100%. And I may steal some of your words if that’s okay?

[IPEsq]

Do you have copies of those X-rays? There’s an ECVM group on FB you can post X-rays in. There’s are some vets in the group and others who study it. They would tell you if the angles aren’t good enough to tell. Might also be able to interpret the rest of it.

I think without a radiology opinion, you are still just guessing as far as the neck. But the Gabapentin response and your vet’s assessment of him clinically suggest neck may be the primary concern. Not that the other things are insignificant. But the QOL assessment may depend on some info that’s still missing.

[endlessclimb]

@IPEsq

But the QOL assessment may depend on some info that’s still missing.

I think at some point it’s A-OK to say “The QOL is not good and does not improve substantially with moderate/intense medication.”

The QOL assessment does not need the answers, necessarily. No one is obligated to keep going down-down-down a rabbit hole trying to find the cause. You try what you can, check the boxes you can, medicate what you can both for comfort and process of elimination.

OP has done way more than enough trying to figure out what might work for this horse. They don’t need a smoking gun to say “there’s a lot going on here, none of which has a good prognosis, and I’m unable to keep this horse consistently comfortable.” That’s what I’m trying to say.

[barnesthenoble]

@endlessclimb

“The QOL is not good and does not improve substantially with moderate/intense medication.”

The QOL assessment does not need the answers, necessarily. No one is obligated to keep going down-down-down a rabbit hole trying to find the cause. You try what you can, check the boxes you can, medicate what you can both for comfort and process of elimination.

OP has done way more than enough trying to figure out what might work for this horse. They don’t need a smoking gun to say “there’s a lot going on here, none of which has a good prognosis, and I’m unable to keep this horse consistently comfortable.”

Just want to second/third/fourth this x1000. OP has gone above and beyond for this fellow and he can’t be kept consistently comfortable as a well-medicated pasture puff. He’s not insured and further dx and tx will easily get into the thousands–and likely won’t change the answer.

It’s okay to be financially and emotionally tapped out. And to be quite frank (I mean well and hope this doesn’t come across as judgmental, because it’s not intended as such), I think at this point further tests and treatments are for the benefit of the humans involved, not the horse.

[Lunabear1988]

Yeah, I’m one that personally would hit a wall of spending thousands of dollars to keep a horse simply comfortable in the pasture (not even in any type of work.) When I was in the situation I also talked about the long-term implications of even trying some treatments too. Some things only help so much or for a limited amount of time.

My wobblers horse had pedal osteitis among other things in his feet and when I talked to CSU that truly was a factor in the decision. We actually had got his feet balanced as much as they could be and he was comfortable feet wise but he had an EXTREMELY expensive set up to stay sound and CSU did bring that point up to me. Basically that it would be cruel to not give him the setup that he needed to stay comfortable and that they acknowledged for most people that was financially not feasible long-term for a pasture pet among all the other treatments or surgeries on the table (which also didn’t spell good outcomes long term.)

[RedHorses]

My vet described it as juggling when talking about my senior’s hoof issues added to all the other stuff.

I describe it like rock balancing. I have the management for each health issue (rock) carefully balanced with the others. One more or less rock could bring the whole thing down.

60 Second Docs video on rock balancing:

Michael Grab The Rock Balancer Defies Gravity

[RhythmNCruise]

Just chiming in to say I’m in NC and my vet does not believe in extending a horse’s suffering for any reason. If owners insist the vet try everything to save the horse or give it more time, of course she’ll do her best within reason, but she will absolutely euth with no qualms if the horse is living in pain and/or has a poor quality of life.

I’m in Eastern NC, though, and I’m not sure where you are.

The idea about going to NC State is also a good one.

[IPEsq]

I don’t think the OP needs additional diagnostics, but every time the neuro discussion comes up, the focus seems to be on his back and KS. I don’t think that level of neuro comes from KS pain even if he has some nerve pain from it. I think he’s got to have a significant problem in the neck. Not sure what “flatter” means…does he have disc disease? I think perhaps if the OP had a neck diagnosis it could help the decision knowing there is a poor prognosis despite any heroic efforts that could be available. But having KS and other lameness and not wanting to do surgery or 4x a day meds for a horse with uncontrollable pain is all enough for many people. But some have different views on retirement sound I guess.

[fivestrideline]

It’s frustrating. Vet is more worried about the neuro issue, but only wants to scope for ulcers? Or try shockwave for the back. Then suddenly we are back to neuro. To be fair, the neuro comes and goes - it got better for a bit and then popped up again.

I wonder if I’m missing something during these conversations with them. I have an email drafted to fire off in the morning since I forgot to send it today. It could sit in the inbox but I’m choosing to wait.

I don’t want to put him down, to be clear. But I do want a frank conversation about QOL and prognosis and my standards for “pasture sound” (which are pretty high, compared to some). If this is a downhill run with little chance of relief within my capabilities, then I’m not going to ask him to endure that.

Thank you to all for contributing, by the way. This continues to be helpful and has guided my word choice in my email. And my “plan” for asking the right questions and making myself clear.

(For someone who has no issues butting heads with higher ups at work, both in person and over email, something about vets and farriers specifically has me struggling to communicate and stand up for my opinions or questioning the validity of my observations. What is it with that?)

[endlessclimb]

@IPEsq

But having KS and other lameness and not wanting to do surgery or 4x a day meds for a horse with uncontrollable pain is all enough for many people.

Frankly, that should be enough for ALL people. Read that again, and ask if that’s something you’d want something you love to endure.

[IPEsq]

My guess is that he suspects the neuro is not treatable apart from the things you have tried. And so if he thinks you are looking for something treatable, ulcers can be treated. You can try injecting and shockwaving the back for temporary relief.

But if that isn’t what you are asking…if his day to day still sucks whether or not he has ulcers or manageable back pain, if he is failing neurologically, then that is the direction you should go with the questions. It’s not uncommon for neuro stuff to fluctuate. That goes into the question of how good are his good days? How bad are the bad days? How many good days does he have? Do you even know the answer if he doesn’t have eyes on all the time?

[IPEsq]

Well it would be for me but I have seen some horses kept going far too long with chronic, degenerative and uncontrolled conditions, so I wouldn’t say that it is actually true for all people even if it should be.

[SBrentnall]

My horse has ECVM and showed no symptoms until he suddenly had a neuro episode at age 14. We did full neck and back x-rays at purchase, but there’s a specific series you need to take to show ECVM. I’ve done it on all PPEs ever since.

[hallie2]

Your horse is beautiful. You are focusing a lot on all the things it might be, going above and beyond as far as caring for him, doing diagnostics. You love him, that’s clear. You seem to be a wonderful horse owner. If he were fixable, you are diligent and would have found the fix. A neurologic horse is dangerous. But imagine being a flight animal whose flight apparatus isn’t working correctly. What if he were to go down in the field and struggle to get up? Personally, I’d focus on his QOL because that’s all that matters to him. You started this thread in July. Has he improved, stayed the same, become worse? I read an article a long time ago, about knowing when it was time to euthanize a dog. The gist was that dogs are all about motion, if they can’t get around, they don’t have a quality existence. Same w/ horses. If his ability to move freely is impaired, painful and not improving, think hard about what the right thing is for your beautiful horse.

[Simkie]

@fivestrideline

But I do want a frank conversation about QOL and prognosis and my standards for “pasture sound” (which are pretty high, compared to some). If this is a downhill run with little chance of relief within my capabilities, then I’m not going to ask him to endure that.

Have you been very, very clear on your desire for this? Like, said exactly this to the vet? What you’ve written here is a great way to ask for this discussion.

If you’re laying out “this is how he is” and expecting the vet to broach the euthanasia topic…that’s just so unlikely to happen. Vets in general don’t bring up euthanasia for chronic stuff like this. They won’t talk about it until you raise it. They’ll suggest treatment options, which it sounds like is what you’re getting.

If you’ve straight up said “I want to discuss euthanasia” and your vet says “I’d suggest treating for ulcers,” your vet is just not hearing you, or opposed to euthanasia in general, or there’s some other weird communication thing happening, and seeking out another vet could be be worthwhile. Maybe asking the question about WHY the vet isn’t willing to discuss QoL or the future or euthanasia would be fruitful, esp if you don’t want to start over with someone new?

I’m just so sorry you’re in this position and feel so poorly supported by your team.