Need collective minds to help my friend's 16 yr old horse

[TWH_Girl]

My friend and barnmate is desperate to help her 16 yr old QH gelding feel better. She has owned him for 4 years and he is WP trained and was shown all around. During this time she has owned him, he has had multiple issues including a check ligament strain, repeated abscesses on all 4 hooves (he’s currently barefoot), injections to hocks, stifles, SI, a shoe boil that won’t heal, a few colic episodes last summer during very extreme heat and currently- ulcers., as well as what appears to be some severe SI pain. Last summer, he did have a displaced colon but he recovered from both colic episodes with conservative care.

This year, he was recently evaluated at our reputable nearby equine clinic for hock and stifle injections which came about after he began short striding quite a bit on the L hind. He was then brought back for repeated evaluation a few weeks later and was still off. He has had ongoing SI and back soreness over the years, and this was still pronounced and not improved after hock and stifle injections. He had SI injection done at the second visit, as well as lumbar facet injections. That was about a month ago. He is also currently being treated for ulcers with 3 meds, the two I recall off the top of my head are Gastroguard and sucralfate.

I am posting the last discharge from the very well respected lameness vet as this gives a pretty detailed history.

Current issues:

• Short striding especially on left hind
• L hip remains dropped and uneven from R side
• Pronounced hunters bump
• Tripping on front feet
• Sluggish- not wanting to move forward
• As noted above, he is currently 30 days into ulcer treatment for grade 3 glandular and squamous ulcers

The lameness vet thinks it could be a very bad case of SI joint arthritis and states he has had a difficult time making these horses sound again. My friend is thinking there is something systemic going on and her normal vet is coming next week. She is planning to have some bloodwork done and check for Lyme and possibly EPM too. Horse is not currently being ridden.

Diet:

• 4 cups of EK daily
• Timothy and alfalfa hay (not sure of exact lbs but BO feeds generously)
• Joint supplement
• Probiotic
• Equioxx (started about a month ago as well)

Any other thoughts on what could be going on with this poor horse?? He has been through so much and just appears to be struggling. Even if it is a mixed bag of SI pain and his ulcers, even any other thoughts for measures of comfort for him would be appreciated.

[GraceLikeRain]

Ulcers and chronic pain can be linked but also aren’t always. Trying to get the stomach happy and making lifestyle modifications is really important. If the ulcers heal but come back, they could be triggered by discomfort.

Have they x-rayed the feet and back/neck? I know rads are expensive but it is very valuable information.

Lyme and EPM sound like good things to explore.

I don’t think massage is going to fix anything but in terms of managing his discomfort, it could be a good investment.

What’s his turnout situation like? I think movement is best with this full body soreness with the caveat that a super cushy bedded stall can also be helpful if they won’t easily lay down in the field.

[bmellison]

I would recommend looking at neck if they haven’t. Mine presented very sore over the glutes and some SI, we think referred from ‘protecting’ the neck. Worth taking the rads at least, this far in.

[TWH_Girl]

Thanks for the feedback. In terms of turnout, he is turned out 24/7 right now until a little bit later in the fall and we move to standard time. Then he’s turned out during the day and comes in at night. Turn out area is a fairly good size paddock but no grass pasture or anything massive.

Feet have not been x-rayed as of yet, though that was something that did go through my head and I’ve mentioned to her in the past. So maybe she can have her normal vet take a look at the hind feet next week when she comes out.

I also agree that the ulcer and chronic pain are probably playing into each other. It’s just a bit heartbreaking.

[Bonnie2]

Reading the vet report, the lumbar/SI issues sound bad enough to be the basis for all the issues except the foot abscesses. Your friend has certainly spared no expense investigating and treating this horse’s problems. Unfortunately there is no magic bullet to cure his back problems. Personally, I wouldn’t feel a need to do further imaging. He may need to live on gastroguard and pain medication. I don’t believe it is approved for horses but meloxicam sometimes helps chronic pain other meds don’t.

[TWH_Girl]

I am tending to agree. As I wrote this out and reread the vet report, chronic SI and back pain is really what resonated. I think if we can find a better medication to improve his pain level, that may be helpful. I thought of meloxicam, Tylenol and maybe a course of oral steroids.

Massage and Magnawave are also some avenues we can try.

[WNT]

Repeated abscesses without obvious cause would lead me to X-ray feet, and check for PPID. I’ve known of a handful of horses that their first warning sign was chronic hoof abscesses.

[Laurierace]

I too am curious about his PPID aka Cushings status

[TWH_Girl]

He was tested for Cushings about a year ago and ACTH was within normal limits. I did encourage the TRH test to be done as it’s more definitive.

Front feet were X-rayed and nothing noted. I may have these X-rays and can post them if I can find them.

[WNT]

After reading the negative plantar angle thread, and the correlation with hind hoof structure and back pain, I’d check those hind feet as well. Just as due diligence.

[4horses]

Pssm type 2 can present as SI issues. Also explains the tripping. Definitely check for EPM. It could just be arthritis.

[TWH_Girl]

Her vet is coming tomorrow instead of next week so that’s good. His hunters bump just seems so much more pronounced now than in the past. I wish there were better options for equine chronic pain.

[TWH_Girl]

Testing for EPM and Lyme and got him started on Elevate liquid vitamin E for possible deficiency. He really has a lot of hallmarks of Vit E deficiency so hoping this helps.

[AW]

Has anyone looked at his hind suspensories?

[TWH_Girl]

By way of physical examination for two clinic vet haul ins- yes. I should try to get some photos of him though- especially last year compared to now. I do feel like he has the SI arthritis but there may be a muscle component involved as well.

Normal vet today commented that he looked sore all over. What’s odd is that he has seemingly declined since injections instead of getting better or not improving- the actual decline in his condition and movement is what is concerning.

[beau159]

@TWH_Girl

My friend and barnmate is desperate to help her 16 yr old QH gelding feel better. She has owned him for 4 years and he is WP trained and was shown all around. During this time she has owned him, he has had multiple issues including a check ligament strain, repeated abscesses on all 4 hooves (he’s currently barefoot), injections to hocks, stifles, SI, a shoe boil that won’t heal, a few colic episodes last summer during very extreme heat and currently- ulcers., as well as what appears to be some severe SI pain. Last summer, he did have a displaced colon but he recovered from both colic episodes with conservative care.

I don’t have specific advice for your friend but just want to say I feel her.

I have a horse that felt GREAT at age 16 - his best year ever in the barrel racing pen. Then all of a sudden was NQR at age 17. Very sore in his stifles and hind end. Couldn’t even hold a lead in the back end to lope. Did all sorts of testing and injections at the vet. Things would “help” but wouldn’t be good enough. I finally gave up after a couple months and just turned him out. He felt a little bit better this year at age 18. At least now, I can lope a circle on him and he can “hold it together” and keep his lead and not fall out behind. I unfortunately haven’t had a lot of time to ride him and try really hard to get him back into shape again. I’ve accepted he can just be my kids’ horse for right now, as I will not return him to the barrel pen for myself, and I’m happy he is at least feeling better from good ol’ time.

Time is the hardest thing and not a lot of people can do that. Especially when it took him a full year to kind of feel better on his own and work out whatever it was that was bothering him so bad.

So I guess my only suggestion/advice if the second vet doesn’t find anything, if your friend can do it, and just give him some time. Unfortunately the vets can fix everything sometimes and it is harder when they are already older.

[IPEsq]

Sounds like he has had the SI treated repeatedly? Was a rectal ultrasound done for the SI and lumbar from that view? Looks like only dorsal imaging here. Might want to consider an orthobiologic in there if the steroids don’t provide relief, but it’s possible the best time for going that route is now in the past.

[TWH_Girl]

I sure hope not but I am aware that may be the case.

Here are photos for any feedback on his conformation or posture/stance. First two are 2020, second two are this summer.

[No1]

Hind high suspensories. It explains the hock flexions, lack of response to injections, back soreness, and posture. This horse needs to be blocked, not just continue to inject and image things. A 2.5/5 lameness is definitely blockable.

[TWH_Girl]

Thanks…I am providing her all of this good feedback. I do not believe he was blocked as of yet, but that is on the list for next steps.