Lameness sleuths… help

[Nevada10]

Buckle up… this horse has a long medical history in his 6 year old life.

As a 4 year old, I had issues with him rearing at the mounting block when I asked him to walk off. I also struggled to get him to go forward (walk to trot, trot to canter) — he would stop and rear. He was diagnosed with dorsal articular arthritis and his back was shockwaved a few times. After a few months with a trainer, he went forward without fuss. I gave him the winter off.

At 5, I had another vet look at him in the late spring because I felt like he was lacking push from behind. He was occasionally missing lead changes (but he was only 5), and it was hard for me to keep him cantering. He was diagnosed with arthritis in his SI joint (I think right side) and it was injected. Shortly thereafter, he went lame on his RF and was diagnosed with a bone bruise via MRI. We changed his shoeing and gave him a few months off. When I restarted him, he was incredibly weak and none of my efforts to make him stronger made a bit of difference. He was diagnosed and treated for EPM. More time off.

When I restarted him again, he was somewhat improved, but the right lead canter was horrendous, and he was very grumpy.

I had a bone scan done at the beginning of this year. Here are the impressions from the scan:
-Right third carpal bone uptake may be secondary to stress remodeling or osteoarthritis.
-Mild to moderate bilateral distal intertarsal osteoarthritis or remodeling.
-Right humeral uptake may be secondary to trauma or stress remodeling.
-Mild C6-7 articular process remodeling.
-Possible 211 tooth region uptake may represent endodontal or periapical disease.
-Right zygomatic arch uptake may be secondary to trauma.
-Osteitis of the distal phalanges bilaterally in front.
-Exostosis of the right second metatarsus.

Nothing lit up on his back or SI.

His hocks and stifles were radiographed — no significant findings. There were changes in his neck.

The attending vet thought the neck was likely the root of our issues, so it was injected. I didn’t see much improvement from the treatment. She recommended trying Osphos, which helped tremendously.

It’s been 6 months since the Osphos injection and he’s struggling with his right lead again. He was doing ok until he was an absolute nut in his pasture one morning two weeks ago… he definitely aggravated whatever was bothering him before. I put him on Equioxx but it hasn’t made any difference. When jumping off the right lead, he will swap his hind legs on take off (only hinds, not a full swap), and will land correctly on the right lead. His left lead feels great. The right lead is like riding another horse — there’s no impulsion at all. He’s much worse in a small indoor compared to a large outdoor. He has never refused a fence and does clean lead changes both directions. The trot starts off a little stiff going to the right but he works out of it and the trot feels the same both directions. Canter transitions are a struggle. Downward transitions from canter to trot tend to be disorganized. He doesn’t buck but will kick out when I tell him to go forward. He dislikes walking downhill.

So, I guess my question is… what did the Osphos help? Should I give him osphos again or try to identify the actual issue and treat it? I really don’t want to rely on Osphos to keep a 6 year old sound. My suspicion is SI and/or hocks and/or stifles. Since he had so much time off after the last SI injection (and I think he had multiple things going on), I can’t say for sure if it helped or not. I’m so frustrated! I just want him to feel good and be happy.

WWYD?

[Demerara_Stables]

I never say this, but I’d stop having the vet look at him. I’m only saying this because you’ve found all you’re going to find with the bone scan and I have a feeling he’s compensating all over and that makes it near impossible to find the root cause.

What’s his life like? Turnout, workload, feed, etc. I’ve had a few horses that were like him that were in pain in so many places that I just put them on equioxx (after inconclusive diagnostics) and longed them for 2 months. Both had back pain. Once the back pain was remedied, we walked for weeks, mostly on the trail, but wherever they were comfortable. You say you’ve given him time off, which was maybe warranted, but that results in a lot of muscle loss. The best way to rebuild muscle is to walk, a lot. And maybe not ride for a long time (how’s his saddle?).

[Nevada10]

Thanks for your thoughtful response. He’s turned out 24/7 weather permitting. He’s on a grain free, forage based diet and gets Lubrisyn and MSM in addition to his balancer, EO3 oil and vitamin E. He does a lot of unmounted work (Pessoa rig and aquatread each 1x per week) and trail rides at least once a week, plus goes for a 10-15 minute walk around a field before and after every ring session — 2-3x per week.

Earlier this year, I did two full months of intense in hand core work. I still do a little every day (backing up a small hill 10 steps x3 per day, carrot stretches, back lifts). I do a lot of walking hills and over cavelleti. He jumps one day a week or less (and not a lot of jumps. All under 3’, usually with a small grid incorporated). Everything I do with him is intentional and focuses on his strength and soundness — lots of trot poles, hills, long and low, etc…. But it honestly doesn’t show. I work harder with him than any of my other horses and they all look and go significantly better than him. I was feeling really optimistic that we were on the right track and he scored an 88 in a 2’6” hunter derby right before he went nuts in his pasture. I was thinking he was ready to move up… and now we’re back to square one

He has a new custom saddle this year that was checked by an independent saddle fitter as well as the rep. It will be checked and re fitted regularly.

[fivestrideline]

Any work on PSSM or MFM or Lyme? Do you keep a record of EPM titers?

[IPEsq]

This all sounds like neck and the things you already found in the lumbosacral region. I’ve also had a horse like this where we also suspected MFM (but he was too young to test, and the diet protocol hadn’t been developed yet at that time). Including going through a period of rearing at the mounting block. Osphos is good for bone pain, and it’s is systemic. Perhaps it helped the spine. My thinking is it probably helped those front feet a good bit. But I think your feet are a secondary problem. Did you image any of the lower limb things that lit up on the bone scan? My problem horse also went through a bone scan at one point, after we had been treating neck but not SI. Neither lit up. Some stuff in his thoracic did but it was a red herring. He did benefit from SI injections as well but he was never right and eventually his front feet were breaking down despite looking great on radiographs. I lost him to colic before I got a chance to make a decision on what else to do for his feet. Necropsy confirmed his SI joints were in terrible shape. All the imaging we had done live had been normal, but there are limits to what you can see. And his neck arthritis progressed despite treatment and careful management over his short life.

I will say that my current horse with some changes in one of his SI joints absolutely doesn’t respond to steroids in the area (and he also has colicked after every steroid injection which also didn’t help). We do ProStride, and it has been a game changer for him.

[greywithchrome]

Did you x-ray his back? I know it didn’t light up on the bone scan, but just curious. His symptoms sound a bit like my horse who has kissing spine… though I think it stems from an old pelvis or SI injury (ive never investigated).

[Nevada10]

His back was xrayed as a 4 year old, and ultrasounded as a 5 year old. The images were interpreted differently by two different lameness experts in the area. One said DAP, the other said KS. A third vet (not lameness specialist) said DAP and KS are the same thing Regardless, he doesn’t seem back sore anymore.

[Nevada10]

He was negative for Lyme each time he’s been tested. He’s only been tested for EPM once — my vet said not to bother retesting him and just increase meds if he starts tripping over poles (he gets diclazuril twice a week and anytime he travels).

We haven’t tested him for PSSM but his diet is low starch (I have a two horses with Cushings and one horse who is IR, so it’s easier for me to keep everyone on the same grain free diet) and he’s turned out most of the time and gets some form of structured exercise 5-6 days per week. I don’t really suspect he has PSSM because the amount of exercise and amount of grass (summer vs winter) doesn’t seem to affect him.

We had two solid months where he was going really well this summer and everything was coming together. I’m so disappointed that it all went away, literally overnight.

[2tempe]

Dont underestimate the cervical changes…there are studies done and growing information on the frequency of malformation of C-6 and also C-7. These malformations can create problems with the way in which muscles/ligaments attach in that area and how well they work.
Some horses show signs at young ages, others when they are 8-10, and doing upper level work, collection etc. I have one in the latter category. He went from ready-for-GP to training level over the last 10 or so months. Inconsistent symptoms, canter difficulty, gaits NQR, fatigue/recovery slow after hard work day, muscle loss. Was sometimes back sore. Some neuro-like things - tripping occasionally, sticky on back up. He lays down more than he used to. Some days just seems generally uncomfortable. I have a CT scan scheduled in a couple weeks, to verify what the vet hospital believes. No EPM, LYME, PSSM. It sucks. Search ECVM online for more info.

[Nevada10]

He doesn’t have ECVM but he does have malformed C6 and C7 vertebrae. They are enlarged on one side. I thought that meant ECVM but according to the expert on the subject who also reviewed his X-rays, he doesn’t have it.

I didn’t see any improvement from the steroid injections, but I did see improvement from the Osphos… that’s what’s throwing me off. I’ve injected the neck, back and SI and didn’t see any improvements with any of them (SI didn’t get a fair trial)… so what did the Osphos affect that we haven’t hit with steroids that made him so much happier? I’d rather treat the source of the discomfort, if possible, rather than the whole horse… Osphos scares me and I’d really rather not use it.

Weak right lead and swapping to the left lead behind for push off over jumps. Those are the two things I’m laser focused on. When I’m grooming him, he dislikes being brushed below his right hip. I feel like it HAS to be something in the right hind.

[trakehners]

Have you checked internal angles in the hind feet? My horse was less dramatic about everything (in terms of rearing and whatnot) but he was doing the same sort of swapping at the canter that you’re talking about and we just figured out last week that he’s four degrees NPA in his hind right and zero in his left (which is also not ideal) (the hind right does not look anywhere near as bad from the outside as that angle would indicate).

He’s had ~inexplicable~ stifle/back/SI issues with no remodeling that we were managing with regular chiro and some injections/mesotherapy but we didn’t look at his feet til now and our vet thinks it’s definitely the driver of all of his other issues (I’ve only been at my current barn since February so all of this investigation has taken place since then). Unfortunately I can’t speak to the rehab/recovery since my guy is getting his fancy footwear next week but it explained a lot when we figured this out, and it’s not a hugely expensive thing to diagnose since it really only requires a set of farrier films in the back.

[greywithchrome]

@Nevada10

I didn’t see any improvement from the steroid injections, but I did see improvement from the Osphos… that’s what’s throwing me off. I’ve injected the neck, back and SI and didn’t see any improvements with any of them (SI didn’t get a fair trial)… so what did the Osphos affect that we haven’t hit with steroids that made him so much happier?

As far as I understand, Osphos is one of the only things that targets BONE pain, which is part of why I asked about the spine. Injections work for joints.

[NaturallyHappy]

This may not be useful at all, but we have one on meloxicam for bone pain. It might be something to try in place of Osphos. It scares me, too.

[Nevada10]

I take radiographs of all 4 feet twice a year now to make sure his feet are on track. He’s in leather pads with bar shoes up front and regular open heeled shoes behind. His angles are good. Front feet had NPA and we’re laterally unbalanced last year (which is likely why he developed a bone bruise). He only swaps his hind lead on take off, not on the flat, and lands on both leads. He’s clearly avoiding pushing off one of his hind legs, but I’m not sure which. When he does this, the left hind is father under him and more flexed, so I assume that means he’s avoiding sitting on the right hind… but the left lead his his stronger lead and the left lead would weight the right hind. So I’m baffled. He looks completely sound at trot.

[Nevada10]

Pamela Blades from Equus Soma said “I see both ventral tubercles present on C6 and no transposition(s) to C7, therefore I don’t believe your horse has ECVM.”

She also said, “These are joints on the upper surface of the vertebrae and are not directly involved with the malformations that define ECVM.”

[Nevada10]

No. This is from the radiologist that read the X-rays. I too thought this automatically meant ECVM which is why I reached out to Pam.

“The right C6-7 articular processes are moderately to markedly enlarged and abnormal in shape with flattening of the articular margins of the processes. Well-defined, ovoid lucencies are present in the cranial aspect of the right caudal articular process of C6. The left C6-7 articular processes are normal in size and shape.
The remaining articular processes are normal in size and shape. The inter- and intra-vertebral ratios are unremarkable“

[IPEsq]

Was that on xray image or ultrasound? It doesn’t sound like ECVM but that irregular joint might need regular injections. Or perhaps it is causing problems with the nerve roots in the area.

Weak right lead and swapping to the left means the horse would rather push off of right hind, not left. But overworking the right hind in compensation could be making it sore. I’d look more at left hind. Or continue with the lumbosacral area.

Dorsal articular process problem is not the same as dorsal spinous problem—the first should relate to the joint in the spine, while latter is KS.

Osphos could also help with pain in the feet that could be due to something you can’t see without MRI. It has a pretty immediate effect on bone pain. Which of course could be anywhere with a systemic treatment.

[Nevada10]

Xray. His neck was injected (via ultrasound guided, to the nerve roots) in February but no improvement after 4 weeks, so he got Osphos at the end of March.

No neuro deficits were found during nuero exam. Myelogram was mentioned but vet didn’t feel it was necessary at that time.

He had a MRIs of his feet last year.

[IPEsq]

I’ve had enough success with neck injections that I think it’s usually worth a try. But in some cases, it does nothing, and there is no other hidden issue. It just isn’t enough. In this horse’s case, I’d still be inclined to go back to the SI arthritis and try a different type of injectable before throwing in the towel.

[Equestrianette]

This is exactly how my horse behaved with bilateral proximal suspensory desmitis. Was the horses suspensory ultrasounded? Did they do nerve blocking on the lameness exam? My horse is 5. Same same same.