mystery lameness/attitude change, any ideas?

[rockyriver7]

Hi guys, long time reader first time poster. Anyone have a guess for what may be causing mystery intermittent hind end lameness, pain/anxiety, and overall attitude change? I am continuing to work with my vet and am simply looking for suggestions of which diagnostic path I should put my money towards next. I’ll try to keep it short.

Horse normally has an excellent attitude and any resistance/anxiety/bad attitude is not normal. Horse is naturally a very emotional guy with a heart of gold. He is normally calm, laid back, and agreeable.

Symptoms have been going on since early November. Horse has only gotten worse. No response to rest, currently in light work (in hand walks, lunging, walk/trot easy rides) focused on being relaxed/stretching. All symptoms worse in cold weather.

Symptoms:

excessively grinds teeth when ridden, groomed, blanketed, etc
girthy, visibly anxious when tacking up
resistant to work, resistant to bend especially to the left
hypersensitivity all over (chest, belly, back, lumbar region, hind legs). Very reactive to palpation all over. More sensitive on right side, but not by much.
Abnormal anxiety with normal tasks
sometimes kicky and protective with right hind.
poor performance under saddle and on lunge line, particularly tracking left.
intermittent hind end lameness— subtle, shifts legs, worse tracking left and on tight turns. My vet had trouble pinpointing a consistent point of origin.

What I’ve already ruled out:
hock arthritis-- he does have mild arthritis (x-rays confirmed) but was injected in August.
Clean x-rays of back, stifles, front feet
saddles both custom fit to him recently and have been checked multiple times.
Blood tests for Lyme, PSSM, and malignant hyperthermia all negative.

Here’s what I’ve tested/treated so far:
Vet did blindfold test and tail pulls and he did both excellently and has shown no typical neuro symptoms.

I suspected ulcers and treated with 8 days of full tube Ulcergard, no response. Also showed no response to SmartGut supplement for 2.5 months and aloe vera juice. Did not scope at that time.

Horse started Previcox 3 weeks ago, and since then has had a big improvement under saddle and on lunge (though not complete), but his anxiety on the ground has gotten noticeably worse. Improvement has been inconsistent— sometimes he feels like his old calm self and sometimes he feels like a fire breathing dragon.

Started Nano-E (vitamin e supplement) about a month ago and a magnesium supplement about a week ago. Only change I’ve noticed so far has been his coat looks great and extra shiny.

Vet is coming out this week to scope him for ulcers and if that is clear, do a more in depth lameness exam. What should I look into next? Any specific diagnostic tests you think would be particularly helpful? Anything I haven’t thought of?

I’d be particularly interested in hearing anyone’s experience with the following suspicions that my vet and I have:
SI issue
Ulcers
Hind gut ulcers
Muscle spasm/other old injury in back
EPM
Vitamin E/Magnesium deficiency

Thanks!!

[AQH]

First, sorry to hear that you’re having a hard time with your guy. I understand what you’re going through. A few years ago I turned to COTH for some ideas on my guy, as he was showing a lot of the same symptoms you described and I was also struggling with spending a lot of money on tests that kept showing nothing conclusive (lyme, radiographs, etc.). Here is a link to that post if you would like to do some reading as to what others said: https://www.chronofhorse.com/forum/f…emeanor-change

After seeking advice and working with my vet, my horse was diagnosed with PSSM. I know you said you’ve pulled blood, was your vet just looking at muscle enzymes? There is a test for PSSM 1 that is fairly affordable, and you just need to send some of your horse’s hair: https://www.animalgenetics.us/Equine…sease/PSSM.asp
For PSSM 2 you could choose to pursue a muscle biopsy. Have you tried changing your guy to a PSSM diet just to see if it makes a difference, along with continuing the vitamin E and magnesium supplements? You said he did not benefit from rest - did you notice if he got worse with rest?

A while after that my horse was diagnosed with EPM (I know!) as we were living in an area where EPM was a common problem. He started showing a lot of the same signs he did before his PSSM was under control, and a lot of the same when he dealt with ulcers, so know that you could be dealing with any number of things, but it sounds like your vet has some good ideas to go off of. I understand it can be really challenging to work with these horses, and I feel for you! In hindsight, I was living 20 minutes away from a veterinary college, and sometimes regret not simply taking him there and instead making numerous appointments with my vet. A lot of headaches could likely have been avoided had I just taken him there, and it probably would have been cheaper in the long run. I’m not sure that that is an option for you but just an idea to maybe get some answers quicker.

Good luck! I’m interested to know how it goes for you.

[rockyriver7]

thanks for the kind response! I read through your post and it does sound similar to what my horse has been doing! so glad you figured it out but sorry to hear about the epm! I am really hoping it is not epm with my guy as I know several people who have dealt with it in their horses and it is no easy feat. How did you diagnose the epm? How did you treat it? Did your horse also have neuro-like symptoms at that time?

I should have been more specific about PSSM-- i did get a normal blood work panel and everything was normal including muscle enzyme levels. I also did the hair test for PSSM 1 and MH and both were negative.
I’ve considered doing the muscle biopsy for PSSM 2 but am apprehensive about it as it would be expensive and invasive. I’ll talk to my vet about diet changes and see what she thinks, but at this point I’d prefer a definitive test.

He doesn’t get worse with rest. Stays pretty much the same. If he has multiple days off in a row or is left in more than usual due to seriously bad weather he will be quite fresh, but that alone is not abnormal for him.

That’s a good idea about the vet hospital. I do live about 1.5 hours from an equine hospital. If I can’t figure out anything with my regular vet this week maybe I will take him there next or consult a different vet in general. I am really hoping for an answer this week! Or at least a partial answer. I personally think he has ulcers and also some sort of back injury but we will wait and see what the scope and exam say.

[IPEsq]

Ulcers seem like a possibility for at least some of the behavior. Did you X-ray the neck too or just the back? They don’t have to be neuro to have a neck problem that affects performance in a lot of these ways.

What stands out to me for the neck are the shifting lameness and unwillingness to go one direction both in hand and under saddle. And secondarily the overall body windup kind of symptoms (the ones that look like Lyme or PSSM).

I have various novels on here about my horse who had these issues.

[AQH]

@rockyriver7 Yes, EPM certainly sucks, but it’s definitely worth considering and the sooner you catch it the better! Unfortunately permanent damage can be done, but if you catch it early then you have the best chance at a solid recovery. My veterinarian didn’t recommend a spinal tap to me for diagnosis, but rather we drew blood and ran an IFAT test. The results combined with what my veterinarian saw on his neurological exam prompted him to suggest treating for EPM. We used Marquis for treatment. At the time his stifles began slipping again as they had before his PSSM was under control, and he began tripping fairly frequently under saddle.

It’s good to hear that you sent hair off for PSSM 1! Unfortunately my guy came up negative for PSSM 1 as well, and at that time we had to pursue a muscle biopsy as my vet was very confident he was dealing with PSSM. I understand wanting a definitive test. It can be hard to make diet changes to see if they improve things because sometimes they can take a long time to show improvement. In the meantime, your horse could be dealing with a completely different issue that goes untreated. So, I definitely agree that a definitive test is the most helpful.

It sounds like you have a good vet that’s willing to work with you to find a diagnosis. I absolutely think that a vet hospital could be a good option if you continue to struggle to find an answer.

I also second what IPEsq mentioned about your guy’s neck - that was something that my vet brought up as well when I was dealing with a lot of similar issues!

[fizzyfuzzybuzzy]

Has your vet tested for other tick borne illnesses? I’m not sure what part of the country you and your horse live in, but tick borne illnesses other than Lyme are getting more and more common. Also, have you wormed recently? There are parasites that give them the same crawly skin feeling that Lyme can sometimes. I second going to a specialist once you’ve ruled out all the usual suspects.

Also, when you did the Ulcerguard, did you administer on an empty stomach?

[tipzythegreat]

I’d look at SI

My horse was similar – just NQR. PISSY when touched in the flank area, tacked, etc. OK working but his heart was just not in it. The BLANKETING! My horse wants to kill me over a silly blanket!

To be honest I haven’t done a total body scan – but I can tell you he had suspensory issues and needed his SI injected. 6 months after our SI injection and my horse has been just plain RUDE about things and just, unwilling to put in all his effort. He’s also super sore in his glutes and whorlbone area. My horse is however “sound”

I think that ulcers often come from being in pain, also – so that could very well be secondary. I would doubt ulcers are making him randomly off and on lame, but the pain could absolutely have caused ulcers and made everything worse.

Good luck!

[joiedevie99]

Definitely scope for ulcers! If you don’t find any stomach ulcers, I’d discuss hind gut ulcers next. There are two tests, although neither is definitive. They are both fairly easy though: ultrasound of the colon to look for thickening, and a fecal blood test.

If that fails, I’d probably ultrasound the hind suspensories, or send the horse in for a bone scan.

[rockyriver7]

thanks everyone!
I haven’t x-rayed his neck and honestly haven’t thought much about it. His neck is one of the only “safe” zones where he isnt hyper sensitive. He is pretty flexible in his neck and usually holds himself quite well. He has no issue reaching around for stuff with his neck, its only under saddle at the trot or canter that he resists bend or can be stiff. However I know sometimes issues can manifest in other areas of the body so may be worth looking into!

Also haven’t checked for other tick-borne illnesses. He has been living in a low tick area for the last 10 months, but prior to that lived in a high tick area for his whole life. So I guess it’s possible he has something that has been hiding out for a while and is just now coming out? Or of course no area is tick free.

For the prior Ulcerguard, I tried to feed on an empty stomach but there was probably 1-2 days where it wasn’t possible to give it on an empty stomach.

Ulcer scope is tomorrow morning so I will update what it shows! I have talked with my vet about hind gut ulcers as well. She said to scope first and then use those results to decide what to do about hind gut ulcers.

Depending on results of the scope, I am thinking of looking more into his SI or some sort of muscle strain. Thinking more about it, around the time all of this started I was asking for more lateral work which is something my horse has always seemed to struggle with. He doesn’t cross over his left hind as well as right. It isn’t always the same but thats one thing I notice more often then not. Maybe that is a clue?

[rockyriver7]

update-- scoped and he does indeed have non-glandular and glandular ulcers. Majority of ulcers are grade 1 with some being grade 2. He also had some yellowing going on, showing he has had some additional acid contact. Starting him immediately on a course of Gastroguard, sucralfate, and miso to address that. Did not test for hind gut ulcers but the sucralfate he is already getting should help those as well if they exist. He is also starting unlimited hay, some small amounts of alfalfa, and more turnout depending on the weather. Long term I will put him on an ulcer supplement. I’m of course sad that he has ulcers and is in pain, (and for my bank account it is NOT cheap), but am happy to know for sure and be able to start him on a definite treatment plan.

For what it’s worth, I will say I wish I scoped him earlier. I’ve seen a lot of conflicting opinions on scoping vs just treating ulcers, and scoping won me over. 100% worth the money to know exactly what we are dealing with, how severe, and where they are. If I am going to spend $1000 on a treatment, I want to make sure its the right one. Lesson learned.

Other than that, the vet said his body soreness and reactivity had greatly decreased, and she attributes it to the vitamin E and previcox. She also remarked that his coat looked “incredible”, and his weight looked perfect. I still think he has a back injury as well, as the ulcers wouldn’t explain the hind end lameness and some of his performance issues. Did not watch him under saddle today as he had been sedated for the scope. We have another appointment coming up to dig deeper into that. She thinks it is likely we will inject his SI, but we will see.

I am looking forward to hopefully having a much happier horse in a few weeks!

[IPEsq]

Give the ulcer treatment some time. Hopefully that’s it, but if it doesn’t resolve everything, I’d still encourage you to check the neck. When we discovered my horse’s neck issues we also had mild ulcers going on. Ulcer treatment resolved a lot of the behavior, but resistance to work, resistance to going one direction in particular, and other performance and behavioral issues remained, which were at that time largely coming from his neck (also a little bit his SI). Neck injections resolved the behavior until he had his next pain issue. He also had a pretty normal clinical exam of his neck, and the vets put off injecting it for some time to try NSAIDs, Legend, shockwave, etc. He also passed a pretty extensive neuro exam. He did have abnormalities on xray and ultrasound.

[AQH]

Good update! I’m looking forward to seeing if the treatment helps resolve these issues you’re having.