Kissing spine: horse worse after injections? Update post 13 neg for Lyme/epm

[GPjumper]

hi all,
for once i am asking for help with one of my personal horses. He was at the trainer’s and after treating for ulcers, he was better but something still wasn’t right in his back. During the repeat scope exam, took rads of his back. He was diagnosed with kissing spine. VERY mild so we injected and brought him back into work as per the vets instructions. (this is a damn good lameness vet so we trusted his protocol). My trainer noticed immediate improvement and felt like he was using himself better/felt much looser over his back HURRAY! wrong: second ride in still in the rehab phase, she went to change directions. He LOST is…Started spinning, bounced off the arena fence etc. He was downright dangerous, his mind had left his body. SO vet comes out again to recheck area. No pain on palpation in the area of the KS. his back felt great. slightly off on the right stifle, but nothing to cause that kind of reaction. I brought him home today and am going to start looking at other options for him and more diagnostics.
Here are my questions:
Has anyone ever had a horse get worse after the injections?
Is the bone scan worth it?
Do i just retire him to be a babysitter and give up?

thoughts/opinions/suggestions are much appreciated.

Chiro comes out next friday to look at him, dentist comes tomorrow AM and the Osteopath will be here in a few weeks.
TIA

[Simkie]

What was injected?

It’s well accepted in human medicine that steroid takes time to kick in, and can cause a painful flare prior to that. It catches a lot of people by surprise, but it’s not terribly unusual and you just have to wait it out.

I don’t hear much about that for horses, but maybe that’s what’s happening? If you’re within a week of injections, and you used steroid, it could be worthwhile to sit tight and see what you have in another week or so.

[GPjumper]

the injections were about a month ago now. I don’t think its a steroid flare. they injected the area between some spinous process and he had mesotherapy done as well.

[leheath]

@GPjumper

Is the bone scan worth it?

KS is very often diagnosed but not the actual cause of whatever the problem is (research suggests up to 30% of horses have it and are asymptomatic) and it can very much be a chicken and egg scenario between KS and other issues. I think the bone scan is worth it - you can spend a lot of time and money chasing other diagnoses. If the spine isn’t a hot spot, the KS is probably not the cause of the behavior. It may show what is (or might be) then you can make educated decisions. Obviously if it shows nothing, then you are no further ahead in figuring out the cause, but at least you will have ruled out a bunch of stuff. However, for the most accuracy, you do need to work/exercise the horse prior to the scan to ensure that whatever the problem is is “activated” at the time of the scan.

[joiedevie99]

How long was the horse out of work? Sometimes rest is really bad for these horses, especially if their natural posture is poor. You could try lunging him for a few weeks in a way that encourages him to lift his back and use his abs. If he’s getting a sharp pain, nerve or otherwise, I suspect you’ll see it on the longe line as well and can stop work.

[GPjumper]

His blow up was about a week ago. He was still in work on the lunge/long lining. I plan to continue with that here until he is seen. Unfortunately, due to the severity of his reaction, he is not safe to continue under saddle.

[awaywego]

We did xrays, confirmed pretty severe kissing spines and injected my horses back 8 (9?) years ago. He turned into a bit of a bronc, dolphining his way across the ring at any opportunity. Prior to the injection he was sore on palpation but his behavior was not nearly as bad as it got after injection and the soreness did not seem do improve on palpation either. The vet who injected him said he’d had a few horses not improve but couldn’t think of one who had gotten worse, but mine most certainly was worse.

Long story short, his back continued to be sore but not in the area where the KS was most severe. We ended up treating for Lyme and his back soreness cleared up. Now whenever his back is sore I check the Lyme titer and pretty consistently it’s up again so we do another round of minocycline.

My own theory about why the injections made him worse? We didn’t know he had Lyme at the time of the injections and were assuming the kissing spines were the cause of the back soreness. Steroids used in injections are an immune suppressant. I don’t have any science to back this up but to me it is entirely plausible that the immune suppression of the injections was enough to make the Lyme even worse and make his back more sore.

I haven’t ever injected his back again and he’s not a good candidate for surgery due to his conformation, so I just accept that there are good days and bad days. The good days are good. The bad days make me want to quit riding Who knows if it’s the kissing spines that makes him the way he is, but I figure most humans of a certain age have good/bad days with their backs too.

All of that being said, in the intervening years, same horse also has been diagnosed with pedal osteitis, so I’m often wondering is it his feet or his back or is it his feet making his back hurt… Like other posters have said, back pain can be a symptom rather than a root cause itself.

[Jealoushe]

If you can afford it and its a great horse, go for the body scan.

[mroades]

Steroid injections can cause flares in EPM, Lyme and ulcers and the timing is usually two weeks to a month after injecions. Something to explore

[GPjumper]

I had pulling a Lyme test and EPM as well he’s not showing anything neurological, but he IS suffering from major anxiety. I’ve never seen him this anxious. As in if he hears something outside or something puts him on alert, he starts shaking.

[awaywego]

My “lyme horse” became super sensitive to sounds/noises and it seems like a permanent thing now for him. He does not show any physical deficits on a neurological exam.

Some (many) horses get super anxious when they are in pain. The anxiety could be from the back soreness - or whatever is causing the back soreness.

[LuvRedHeads]

I have had multiple horses that became incredibly anxious and reactive in general when something was hurting them.

[GPjumper]

I figured I would give you guys all the updates. EPM and Lyme came back negative. Hair is at UC Davis for PSSM1 genetic testing.
Shockwave worked great for 48 hours, then he got extremely bad and leveled out to about the same 3 weeks later for second treatment. Second shockwave treatment was Monday, seems to be better, but still incredibly anxious.
Switched all his feed to something 11% nsc and am going to start gastrogard again to see if that helps.
Next step, IMO is to x ray all four feet.
Is there anything else I could be missing?

[Pezanos]

On my ulcery/kissing spines OTTB, Ulcergard/Gastrogard made him worse. Sucralfate, Nexium/esomeprazole helped. I can’t explain why, but Ulcergard was a no-go. Fortunately, it’s super cheap to try the esomeprazole instead. I don’t know if it would solve an issue of this magnitude but it can’t hurt and it could help.

[GPjumper]

What is the esomperazole dosage? I am open to trying this as I think his gut stuff hasn’t resolved.

[Simkie]

@GPjumper

Next step, IMO is to x ray all four feet.

When you start looking at multiple sets of radiographs, definitely compare $$ to a bone scan.

Good luck, this sure sounds like a tough one to figure out.

[Pezanos]

I used 1 bottle = 1 tube of Ulcergard and followed the normal ulcer protocol: 2 weeks of the full dose each day, then tapering down. There is a very good (long) thread on the Horse Care forum talking about different dosages that have worked for others- most common was 3 capsules/day. So maybe look at that thread and/or the clinical articles supporting the different dosages and decide what’s best for your horse. I really do hope it helps. These bad horse puzzles stink.

[Cocorona]

OP- the way I understand lyme is that it flares monthly in the cells and it’s possible to have a false negative if you don’t test in the middle of the flare- possibly something to check in with the vet on? The lyme test is kinda pricey so may be worthwhile to do a round of doxy if you can’t find other answers and see if it helps…obviously with a vets agreement and approval sorry you’re dealing with this. Wishing you answers and a healthy horse!

[M]

I have been curious about Tad Coffin’s device but have not used it or know anyone who has.

Tad Coffin has a device he rents called a Thera-Tree.

Horse Back Pain Treatment | Improve Horse Performance | Thera-tree

His site shows a horse with kissing spines ( and before and after x-rays ) and results of using the Thera-Tree.

Thera-Tree® Therapy for Kissing Spine

[GPjumper]

Hi Lyme titer only showed the vaccine. No exposure to Lyme disease itself.
I have the Thera tree already. It’s not working for this guy unfortunately.