Neurologic symptoms- opinions please! VIDEO- UPDATE post 12

[RnR]

I have an almost 22 (in April) year old Thoroughbred gelding. Raced until he was 8, evented up to Novice until around 18, retired to 1st level dressage and trails for the past 3-4 years. Always healthy, no major soundness issues, I have owned him about 11 years now.

I moved him to a new barn 7 months ago, and have been riding him on light walk/trot trails and light dressage work in the arena about 2-3 times a week, just to maintain muscle/suppleness/balance. A few weeks ago the barn manager mentioned he is eating fine, but not trotting to his hay pile in the paddock like he used to. About a week after that she mentioned he was not lunging out of his stall at other horses like usual (he is the barn terror). Around the same time, we switched his paddock buddy from a gelding to a mare because he tends to be very dominant with geldings. He was VERY “excited” with the new mare for about a week, then got over it and did his own thing. All of these things were subtle, and not really anything I felt I could call a vet over since his temperature was good, he was still happily eating all his hay and grain, and he was totally normal under saddle.

Fast forward to last week. I had the flu for a week, and by the time I got back out to the barn, barn manager told me as soon as I got there something was not right, he was struggling to turn around in his stall that day to get to his corner feed bucket. I took him out of his stall and he was tripping/stumbling with his front legs, overreaching and with his hind and hitting his fronts, and generally not right. I called the vet who said to give him 10mL Banamine and she would come in the morning. He stumbled down onto his knees several times, and was very ataxic, so I left him in paddock overnight because I feared he would fall and hurt himself in his stall.

Vet came the next day and seemed to rule out EPM based on symptoms, but pulled blood anyway. That is sent out, awaiting results. He cannot back up, has trouble in tight circles, ataxic on all limbs, and she reports he was tender to palpation in C5-7 area. She mentioned that given his age and history, it is very likely that this is cervical arthritis. She stated we would put him on a Dex regimen for the next 12 days and see if that helps. In the meantime, we would run a blood panel, and wait on the EPM test. She recommended never riding him again, even if symptoms improve, as the best case scenario he could be a pretty pasture ornament, or as worst case, if he remains ataxic, to consider putting him down.

Barn manager called me as soon as she heard and stated she thought I needed a 2nd opinion. I have the other vet coming tomorrow to look at him.

I have a few thoughts or ideas concerning all of this- not sure if they are logical or not, or even worth mentioning to the 2nd opinion vet as I don’t want to muddy the water, which is already confusing.

1. He was wormed with Quest Plus the same day he became severely ataxic- not sure if it correlates since he was NQR starting 4 weeks prior, but never neurological until that day.

2. Is it possible with how rambunctious he was with his new pasture buddy that he Acutely injured/pinched a nerve, rather than this be a chronic degenerative neck arthritis?

3. I often walk him down to a large field with a drainage ditch since the new barn has only dry paddocks without grass. I hand graze him out there about 1-2 times a week for 20 mins. The week before he became ataxic I was hand grazing him out there when a neighbor came out and asked if I was aware that it is county land and they spray mosquito spray all over the grass/ditch about once a month. I was horrified as I have been hand grazing him on this luscious grass for the past 7 months, and immediately moved him off the grass. Any chance this could be a result of poisoning?

4. All of his blood work came back healthy, ie liver enzymes WNL, RBC, WBC etc all in normal limits- would they be abnormal if it was poisoning?

5. He has never given ANY indication that he was in pain- never resistant to move, girthy, hesitant to collect etc- Even when he is stumbling around ataxic he doesn’t appear to be in pain and will attempt to continue to graze the whole time. If this was severe neck arthritis, wouldn’t there be some physical indication he was in pain prior to neurologic symptoms. I knew a horse who had to be retired due to severe cervical arthritis, he would randomly explode in cross ties, or bolt/kick out when you jumped or tried to collect him. My guy has not so much as pinned his ears back under saddle.

6. We are now on day 7 of Dex. He has gotten better with the ataxia, but not great. I have noticed that he can walk very evenly with no issues as long as you are moving forward. He starts stumbling/dropping to his knees when he is grazing or eating his grain off the ground. What’s the deal? I have also started him on Vitamin E and aloe. On the plus side, his personality is a lot perkier, he is nickering for his grain and pinning his ears at horses again.

Any thoughts or suggestions? If the 2nd vet recommends neck rads, is it worth it? I read a study where nearly all Thoroughbreds over the age of 10 have neck arthritis. So I would assume at 22, he likely has it, but is it the reason for all the symptoms?

Thanks for anyone who made it to the end, sorry it was long! I am uploading a video of him walking from today. I will attach it in a bit.

[RnR]

1st link is him walking at a normal pace where he doesn’t trip very often. 2nd link is when I let him walk around and graze, he stumbles a lot more often, sometimes going down to his knees. All videos taken on same day.

https://1drv.ms/v/s!AoSjD6f1dp7yjhQz1_547ACGqejV

https://1drv.ms/v/s!AoSjD6f1dp7yjhX1HpjmBaYAvX8T

Hind end weakness:

https://1drv.ms/v/s!AoSjD6f1dp7yjiHa4dnfmXoTaEQB

Happily walking again:

https://1drv.ms/v/s!AoSjD6f1dp7yjh_mUMpVC1LXy4LQ

[FalseImpression]

I am sorry. It reminds me of the horse I had to put down a year ago in November. Severe neck arthritis due to a long ago trailer accident. He started tripping and stumbling under saddle 3 years before and my DD stopped riding him.He was fine as a pasture ornament for a long time, but it started getting worse in the fall of 2015. Took him to vet hospital for neck x rays which showed arthritis at every vertebra. Vet said to be careful as he could hurt whoever handled him and he could fall and hurt himself. Less than a month later, he got worse almost overnight… and I made the hard decision to let him go. Until then he was still happy, but then I saw a worried and stressed look. He scared me to the point I would not go in the stall with him. My BO was wonderful and supportive and kept saying they’d be careful. But I looked at his eyes and I could not keep him going.
We miss him terribly but also realized how much stress we were under.
Neck and feet… they can’t live without good neck and feet!

[RnR]

False Impression- sorry to hear about your loss! Horses are such a joy and a heartbreak at the same time. Did you manage your guy with anything special? I am trying to weigh options if the 2nd vet comes out and agrees that this is cervical arthritis. My parents own 5 acres with my retired pony on it. I can put him out there, but I want him to be comfortable and happy, and not a danger to my parents either.

[IPEsq]

One thing neck rads could tell you is if this can’t be due to arthritis (if they happen to look pretty good). They could also tell you if the degeneration is really bad. If there’s moderate arthritis then it can be hard to tell if this ataxia is due to that or some other cause. Maybe consider something toxic. When he had the flu did you test for anything specific?

[RnR]

Great point IPEsq about the neck rads. If 2nd vet recommends them, I will likely let him take them. I was wondering about creeping indigo since it seems to be all over Florida, but I believe that progresses a lot more rapidly, and he hasn’t gotten any worse in the past week, if anything slightly better. I was also concerned about the mosquito spray on the grass he has been eating. I have been trying to find any information on that. To clarify, I had the flu for a week, not him. But we did do a blood panel on him and sent out for an EPM test. Blood panel all came back healthy, EPM results I am still waiting on, but vet indicated it is unlikely at this point.

[Peggy]

I think some of the things that you mentioned could be causing the issues, either singly or combined, or they could be exacerbating an additional issue.

I wonder if he gets worse with his head down bc the different neck position causes something to pinch or pinch more.

[UrbanHennery]

Could he have had a slight stroke?

[maunder]

@UrbanHennery

Could he have had a slight stroke?

I also wondered if this had been ruled out. My Morgan horse experienced severe ataxia due to a stroke. He was about 24 at the time.

[RnR]

I will ask the vet today, good suggestions.

[FalseImpression]

My guy was 22 and had a bad trailering accident with his former owner about 12 years before. By the time, arthritis, stumbling (even falling once) appeared, he was mostly retired. We only owned him 2 1/2 years but had known him for 8 and looked after him for all that time. We knew about the accident and all the treatments he had received at the time. He was a great jumper in his day, but my DD never jumped him… hacks that he loved…but he started not going straight even at a walk, once got down on his knees with her on him bareback. She got off and never rode him again. When he stumbled in the field, he could compensate, With a rider he could not.

Our vet did not recommend any treatment really except the X-rays which we did… it was sobering. The vet hospital did not recommend anything either. He was too compromised already. We double Previcox for a while but not sure it did anything. He was not in pain. His shoulder muscles atrophied almost overnight too.

On Saturday, he started swaying in the x ties…On Monday, he tripped walking off a rubber mat and swaying in his stall. I would not go in to put a blanket on him as I would have had to get between him and the wall. My BO put the blanket on in the morning. On Tuesday, I had called the vet and made the appointment for Friday. Called my BO and she said she thought he was not going to make it to the field, tripping so much. Called the vet back and moved the appointment to Tuesday pm.

My DD left work right away and spent the day watching him in the field. He rolled and did get up! He saw her and came to the gate, but she did not want to bring him in or change anything to his routine. We all cried but felt relieved as well.
We were worried that with winter coming… snow, ice, irregular ground… he would trip and could have broken a leg or shoulder.

It was a very difficult decision but we knew we would have to make it, just did not think it would be as soon as it was.

[RnR]

UPDATE-

EPM blood work came back. The vet said they usually don’t worry about it if the levels are below 600. His titer showed 1280.

He ultrasounded his neck and said that he did see some osteophytes present on his right side between C5/6, not so much on the left. This means, he still can’t rule out cervical arthritis, but he did not think he appeared at all painful, and thought that rather than shipping him for cervical rads, given his high EPM titer, money would be better spent pursuing treatment in that direction. He said the neck osteophytes could play a role as well, or they could just be an incidental asymptomatic finding. He did not want to try a spinal tap because he is is afraid with sedation he would lose balance and become dangerous.

I am not sure how I feel about this. On one hand, I would be happy/relieved if this was indeed EPM because in my mind it has a better prognosis since it is treatable, rather than progressive neck arthritis. On the other hand, it is so expensive to treat, and if this is not EPM, I just dumped a bunch of money.

Just ordered the Marquis. The vet warned me it will get worse before it gets better, and to put him on bute as well as soon as I start the Marquis treatment. He also warned of potential relapses. I have him on aloe and Vitamin E. Any other recommendations or experience with EPM?

Forgot to add- he was grade 3 on the neuro scale. Vet said I can maybe hope to make him a grade 2 with treatment, which is still by no means rideable. But I will try to count my blessings and be happy if I have a happy, comfortable, pasture ornament.

[FalseImpression]

I hope this is good news and that you can treat him. My guy was a 4 going on 5 when assessed at the vet hospital. And we knew it had nothing to do with EPM (which is not rampant around here).
Best of luck. Keep us posted.

[trubandloki]

Jingles for your boy. Sorry to hear about the diagnosis.
Hopefully he does well with the treatment and becomes a silly happy pasture puff that collects kisses and treats for a very long time.

[Lord_Helpus]

Many people keep horses alive “because I would miss him”, and that is not a valid reason.
Just last spring (seems like a decade ago) I had to put my wonderful boy, Waldo down because of neurological problems from multilevel neck arthritis and degenerating vertebrae. He was 5.

I kept going until he took a turn for the worse and became potentially dangerous to both himself (falling) or others (falling on his handlers).

If he is not in pain and is not a danger to anyone, then you are not hurting him by keeping him alive. But, from what I learned from Waldo, your boy, at his age and his condition, might not improve.

Your own financial position is a valid consideration. Considering that, and given the chance that he might never improve enough to live normally, I do not think it would be unreasonable to euthanize him.

Best of luck whatever you decide.

[RnR]

Thanks Lord Helpus for that point of view. I have definitely considered euthanasia, and will if I cannot make him comfortable. In the meantime, I have started him on EPM treatment. I am really hoping for an improvement, but aware that this may end poorly. He is worth the effort. I have owned him 11 wonderful years, and I owe him an attempt at treatment, and a decision to PTS if there is no improvement to have a good quality of life.

[2tempe]

OP - Tough situation, I was in your shoes several years ago, but it turned out to be arthritis and not EPM.
Just one word of advice, obvious though it may be. ANYONE who handles the horse (farrier in particular, but also barn staff, family, etc) should be told about his neurological condition and warned to be very careful when handling. I relied on my farrier for non-medical periodic assessment as to his ability to comfortably have his feet done.

I only tranquilized him for the dentist, but if you can find one who can do w/out drugs it would be easier.
Good luck w/ your boy.

[Damfarm]

My. 22 yo has EPM grade 2/6. Never fell down but ataxic and has some muscle atrophy. Treated with two rounds of Marquis about two weeks apart. Treatment finished end of September. Improved to the point where I was riding again in mid October into November. Began seeing mild signs again in late Nov. Had him tested by Pathogenes and is just completing treatment with Orogin ($200) 10 day treatment. Considering electroacupuncture as well. I will let you know how we make out as it is hard to know what to do. I have had my horse since he was born so do not want to give up on him. You might want to contact Pathogenes. Marquis was very expensive and honestly the effectiveness is sketchy. With my horse, they are recommending follow up with Neuroquel but not until we give it about 6 weeks post treatment of Orogin. Good luck.