NQR Horse, possible neck issues - inject, CT, inject and CT?

Hi all! Sorry this is long.

6yr old OTTB mare, came off the track in spring 2022. I adopted her from an aftercare program in August 2022. She is missing her left eye (removed Dec 2023).

In July, she started sitting back on crossties when she was getting done by the farrier. This ONLY happens with her front legs. It seemed like behavior at the time–she was in general anxious in that part of the barn and a little herd bound. Got dorm gel and that worked like a charm so we kept doing that. (Hindsight is 20/20 as you’ll see.)

She sustained a mild suspensory strain in September and was off from September to December, handwalking and tack walking though it was mostly like flying a kite even with drugs.

Her suspensory healed quickly and in November she was cleared for tack walking and medium turnout, but when I tacked her up, she was pretty angry, which wasn’t like her. She also was a little off her feed. We scoped and she had Gr 3-4 ulcers. Treated for 30 days with Gastrogard and Sucralfate. Rescoped clean, no ulcers at all, at 30 days. Her suspensory also scanned great at the same appointment and she was cleared to slowly return to work.

In January, I switched to a new barn and a new farrier. Even through dorm gel, she sat back repeatedly on crossties, attempted to rear, hopped, and had a very hard time holding up her foot long enough for the glue-on shoe to set. Again, only with front feet. I’d never seen this happen through dorm before, so I asked for a vet exam and xrays.

Her exam was not remarkable, except that she really does not like her front feet held up for any period of time. Long enough to pick them but not much more. She was sound (slight positive both hind legs on flexion, but her hind feet are quite NPA right now). She did fine with the tail pull.

On tight circles, the vet noted that she walked a little wide. Going up and down the hill with her head held up, she floated her front feet a little bit. Vet graded her a 1 for neuro.

Xrayed her back and her neck. Her back has one very small and minor spot of KS. It’s not touching in the xray but it’s very narrow and there’s some remodeling there.

Her neck was not catastrophic, but it does have some enlargement of C4-C6 facets, a weird bone cyst on a facet of C5, and some “abnormalities of tranverse processes.” We didn’t see anything super alarming on field xrays of C6-C7, fwiw.

She has a history of explosive energy (especially if she gets insufficient turnout) and being a bit hot/cold under saddle. She also has a history of balking, though that really has gotten better and better when we’ve slowly fixed her feet. She has terrible angles in her feet.

I feel certain that there’s a pain component to her behavior, and maybe also pain memory. The question is whether I just inject at this point, or if I take her in for a CT and neuro exam at a clinic, or if that’s a waste of my money and I should just inject and see how she does. I can’t afford a myelogram at this point in time.

Is there a possibility this isn’t her neck, and she’s just so used to her feet being in pain that she has learned not to hold her feet up? I’ve never done bute before a farrier appointment.

We’re going to do a bute trial next week (with gastrogard and sucralfate on board) to see if we see any difference under saddle and on the ground when I’m testing this.

We did pull a Lyme test and it was negative. This is an endemic area.

Open to all thoughts, though if you only want to share a horror story, please scroll past. I’ve heard plenty from well meaning people over the last week and I can only handle so much panicking at once. <3 Thank you.

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I have one that doesn’t like holding up/stretching forward her RF. When she came to me, her owner didn’t really have the money for diagnostics so we just babied her the best we could to get her through it. Her feet were also a mess and I have a feeling she had some rough handling before she came to the previous owner. She was a mess in her body (no avert lameness, just very very muscle sore/tight) when she came as well, which I’ve fixed with a lot of body work and correct riding.

We never had to dorm her but we did give her bute the morning of the farrier appt. 3.5 years later, I now own her and she still doesn’t love having that foot worked on, but I don’t need to give her bute. Her feet are significantly better (also now barefoot) and my farrier just makes a point of not pulling the RF really far forward to place it on the stand when he trims it.

I understand glue ons require a lot more standing still. Have you discussed with your farrier switching the type of shoe so that she can stand with the foot on the ground as the glue cures? Shoes with indirect glueing (such as most EasyCare shoes) don’t require the horse to hold the foot up as the glue cures.

Yes, he’s eager (understandably) to get her back into steel, but feels like he needs another cycle or two in glue-on to get her feet in a better place. She has not been in glue-ons in awhile, and was in steel when this started.

That’s interesting. The mare I have was in steel as well when she was having this issue (she never went to glue ons).

I would agree a bute trial for the appt would be useful. I don’t think that injecting the neck is something I’d do, since it seems like the only symptom that she might be having is not holding the foot up - that could be a lot of things. If the bute works, you could try a round of adequan.

Do you know what kind of shoes she’s in now? I think the polyflex have to be held up to cure. The versa and octo shoes from easycare allow them to stand while it cures, so I’d see if your farrier has experience with those.

With history of ulcers, I’d really consider Tylenol rather than bute.

What would a CT change in your treatment plan? You’ve got changes on your field rads and a wonky exam. I’d inject–you’ll get another look at things with the ultrasound when you do that–and go from there.

Have you tested for epm? That’s also definitely worth a look and can cause all sorts of weirdness.

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We haven’t tested for EPM. My vet would prefer to do that in clinic vs a field test. Right now I’m scheduled to go into the clinic for neuro/sports med in a month (because of coordinating schedules). I’m inclined to ask my vet to block her feet on the farm first but also need to be mindful of money.

I’m anxious about her gut too but hopefully the GG and sucralfate do their jobs.

It’s a blood test. The spinal tap isn’t really necessary anymore.

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My understanding is that the blood test isn’t wholly accurate, and since she doesn’t have other EPM symptoms (like spookiness or tripping or any muscle wasting, or loss of body condition), it wasn’t high on the list.

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That’s not really correct, and the fact she has a positive neuro exam means it really should be ruled out. I assume if you’re endemic for Lyme you’re also in a high epm area (they seem to have a large degree of overlap.)

In your shoes, I would rule out epm before treating or testing for anything else. It’s relatively cheap and easy.

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We were dealing with just a tiny bit of NQR and after exhaustive xrays decided to inject. It was quick and combined with some daily stretching, I’ve seen a world of positive change. I put it off for a year, and regret waiting. It really did help. But I only did it once - that was about 2 years ago and things are still great, but I do stretching exercises very regularly. Happy to share what those are if you’re interested.

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I would try injections, and if not successful a CT scan. We have one horse in the barn who vetted great. Must have had an accident in shipping or something that wasn’t disclosed. Now has noticeable arthritis in the neck, after less than 6 months from prior imaging. Injections didn’t help, but CT revealed that the arthritic changes are causing a narrowing / pressure on the nerve roots, and the recommendation is to do the surgery to widen the foramen on the worse side (they won’t do both at once regardless) to relieve the pressure and see how that goes. You can only judge an issue like that with the cross sectional view in a CT. Horse also had myelogram which was normal. With an issue not all the way at the base of the neck, you may be able to do a regular CT with standing sedation.

Absolutely agree, especially with the positive neuro test.

My guy has neck issues; slight degenerative changes at C5-6-7 and some mineralization in his nuchal ligament at the poll-C1. While the images look “mild”, this results in knee buckling, and he has gone down on me once.

It’s currently managed with Equioxx and electro-stim acupuncture. No idea how much time that will buy us, but we’re making the most of it.

My guy also threw a moderate titer on the EPM bloodwork when getting everything worked up, so he did get treated. It really ruled EPM out as it didn’t do anything, and the NSAIDs/Acupuncture are doing the trick.

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Were blocks done? She is “quite” NPA in both hinds, correct?

What if she is bilaterally lame due to the NPA behind but you are only seeing it when she’s asked to load the hind end more when her front feet are being worked on. Has the NPA been addressed? Footiness wouldn’t necessarily show on flexions but could become very apparent if one foot is blocked.

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Completely agree. EPM blood test first, see where the titer comes back, and go from there.

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This is a good question. She just got hind shoes back on (pulled them during suspensory rehab) and farrier wants foot rads before we consider wedges. But yes, her last foot radiographs were over a year ago and she had NPA to flat angles in all four feet. Previous farrier was working on getting toes back but hadn’t mentioned wedges. Current farrier would like to wedge to correct. We haven’t blocked yet but after reading another story here on COTH, my vet and I are going to set up a day to block her feet.

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I’m convinced, haha. When she’s back to block feet, I’m going to ask for the blood test for EPM as well. Thank you!

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I don’t have anything helpful on the injection question, but I wonder if maybe a different shoeing protocol might help.

I have a 30 year old mare who I adopted 4 years ago. Significant arthritis in her hocks. She is comfortable getting around, but really struggles with holding up her hind feet up for the farrier. My farrier is great with her - picks her feet up only a few inches off the ground to trim. On a good day she’ll use the stand to clean up her toes.

But to help I give her Tylenol the night before and again about an hour before the farrier arrives. She also gets 2 ml of ace (900 lb horse) to help with her nerves. The ace doesn’t sedate her seriously, but it does reduce her anxiety. Finally, I don’t put her in the cross ties but hold her lead rope. I think a lot of horses do better on a lead rope rather than the cross ties as a general matter, plus you can help them position their head in a way to help their balance. For my mare, she obviously was taught to respect a hard tie at some point in her life and she really settles with a firm single point of pressure (I use only when necessary). So maybe some small things you could try.

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I haven’t tried giving Tylenol (or bute) before farrier appointments. Ace doesn’t do much unfortunately. And she’s not better if I hold her lead rope and don’t crosstie, unfortunately.