NQR young horse - hind end issues (retitled from ulcers / kissing spine focus)

[EventingMaff]

UPDATE: Lyme test came back negative, Vit E came back low (129 in August, 190 now) Feels like that could be a contributor but onset of issues feels too sudden to be full explanation. Plus she felt GREAT in Nov so next steps are ulcer scoping, KS xrays, and if still nothing then we’ll likely inject SI. Would still love others input / thoughts / own experiences on any and all of those issues!

Looking for people’s experiences with how their horse presented / showed symptoms when diagnosed with Lyme and / or ulcers. Also, reliability of Lyme test (I know in humans it’s low, is that not the case in horses though?)

My mare is clearly uncomfortable and in physical pain, yet lameness work up by vet didn’t show anything decisive. Blood has been sent away to test for mineral deficiencies and Lyme, next step would be to scope for ulcers.

Situation / timeline:

• Horse is young and due to (my) pregnancy and then COVID has been picked up and dropped a fair bit so has never really come out the other side of young horse weakness / imbalance
• August: chiro recommended getting her tested for Vit E / SE due to persistent pelvic stiffness - levels came back low and she was started on supplements and felt GREAT.
• Late Nov: Chiro (also saddle fitter) said saddles looked good and said she was the best he’d ever felt her
• Early Dec: Canter work (always toughest gait for her) deteriorated with increased swapping behind and getting hot / anxious in anticipation of canter ; Trot work felt OK except horse has always leaned on the left rein / hollowed on the right and suddenly (like in a day) it switched to leaning on right and hollowing on left
• Dec 12: Horse bucks when asked for left canter. 2nd time in 2 years that horse has ever bucked (first time was first time cantering in an open field with other horses and it was a gleeful and small “YAY” buck - this was a heels above ears pissy buck). Pushed her through it but rest of ride was stiff and tense.
• Dec 15: Next “working” ride (days off and walking trail ride between) - Leasee rode and when asked for left canter horse went full bucking bronco. Leasee is a confident Prelim eventer used to hot headed red head mares…when she says a horse is “unrideable” I take it seriously.
• Dec 16: Lunged horse without saddle - fine to right (but with lots of switching behind in canter); Turned to left and horse went full bronc, trying to tear away from circle, bucking hard - could only get her back under control by bringing her down to a 10m circle. This is a horse that is incredibly responsive to voice commands typically.

Since Dec 16 horse has been on full “vacation” mode - still turned out but no work (not even hand walking) until I know what is going on. Despite no saddle for 2+ weeks, running hands down her spine has her nearly on her knees (with only moderate pressure). Lunged her Dec 27 and while she didn’t go full bronc, holding any circle at the canter was clearly very hard and to the left a few pissy bucks were thrown at first departure.

General throughout timeline: Horse seemed increasingly “sensitive” on the ground. More look-y, less tolerant of blanketing / haltering. Probably un-noticeable by someone who doesn’t know her, but she’s usually a very laid back mare and she’s just been a bit edgier the past couple weeks.

Does this sound like Lyme? Hind-gut Ulcers? Something else?

[joiedevie99]

I’d check both of those things given the history. I’d also re-run Vitamin E/Selenium given that for most horses the change in seasons comes with some accompanying change in diet. I’ve seen a lot of weird EPM too, but that would be lower on my list here because you seem to be able to produce the problem under a consistent set of circumstances - cantering left. With EPM, I’ve seen similar things but there has never been any consistency in the triggers.

How did the lameness exam go? It’s always hard for me to accept that there is no lameness, although its obviously possible, without knowing how experienced and thorough the vet was.

[skipollo]

Lyme: my horse presents as sore, not limping-lame but not right either, anxious, hot, inconsolable when he’s having a bad day. His symptoms would come and go–one day he would be perfect, the next he would be a total disaster. Overall soreness/arthritic in his entire hind end. Lyme is tricky because it disguises itself as so many different things, and it feels like you’re chasing symptoms that are never consistent.

Ulcers: my horse presents as lack of appetite/weight gain and being hot to ride. He doesn’t get girthy, crabby, coat is always very shiny and slick.

I had the Cornell test done and haven’t read about any accuracy issues with it. That doesn’t mean they don’t exist, I just haven’t read about them.

If she’s reacting that poorly to moderate spine pressure I’d be xraying for KS as well.

[EventingMaff]

lameness exam highlighted several slight issues but nothing overwhelmingly obvious:

• Moderate hind foot soreness (she’s barefoot; but ground had just frozen days before she’d been running around like an idiot the day before in turn out – Farrier had been to trim the week before and hadn’t noticed any soreness at time)
• Hind legs, particularly left, swinging out and around at trot - Not severe, and horse always has had slight ‘swinging’ behind but definitely more pronounced and more noticeable in left
• Less forward / tracking up than usual; horse isn’t hot but is usually very willing to go forward and definitely needed more encouragement to move forward on the lunge
• 1-2 tight steps after left hind leg flexion (when flexed up and under belly) but then fine

So definitely NQR, but nothing that screamed “oh there’s definitely a problem with XYZ” either

In further reading, the other thing crossing my mind is SI pain. Horse is 5 so the idea of having to inject this young (and this lightly worked) really pains me. REALLY hoping it’s not KS. My last young mare was diagnosed KS at 6, although her symptoms presented differently. Fusion surgery didn’t work and she’s not a pasture puff at her breeders. A KS diagnosis would feel devastating

[pokesaladannie]

Have you had a reproductive exam done? I would want to eliminate the possibility of a painful follicle that may be stuck.

[skipollo]

Another thing to think about is her angles in her hinds. My horse was having some overall soreness and NQR-ness (before having the Lyme test done) and we xrayed his hinds. He was NPA. That can make their entire hind end sore and off.

My vets told me that SI pain is usually secondary referred pain coming from an issue lower down. If (for example) stifles are sore, they compensate with their SI area, which then also becomes sore.

[EventingMaff]

Hmmm that’s a great point. We did have rads done of her feet a year ago but may be time to do another and see if something changed there.

Vet is scheduled to come out to scope for ulcers and do back xrays, I think I’ll have her do feet while she’s there.

[Posting_Trot]

If your horse had the Cornell Lyme test done, that’s pretty accurate. The results should have been reported to you in terms of ranges that indicate whether there’s any room for doubt about whether the horse has an active infection. You can ask your vet for more clarification if they didn’t report it to you as a set of numbers within ranges.

It would be worthwhile supplementing your horse with Vitamin E (go for the natural rather than synthetic version). It’s relatively inexpensive and it might help. Elevate is a great brand. You don’t mention selenium, but if you live in an area that has low levels of selenium in the soil, it’s possible for the horse to be deficient in that as well. And it’s often supplemented with Vit. E. You can talk to your vet about that. Again, it’s cheap to try.

The hooves and how they’re trimmed and shod can make a huge difference in terms of pain for the horse. It might be worthwhile to post some images of your horse’s hooves.

[EventingMaff]

So she’s on Elevate Se (1000 IUs) and then additional pure natural Vit E (4000 IUs from human gel capsules) for a total of 5000 IUs per day of Vit E. Not sure of Se totals but she wasn’t as low in Se and vet was less concerned there since increased Vit E would help with Se absorption too. Vet now wants me to nearly double her Vit E to 8000 IUs - which feels high for a 15.2 medium-build horse but her levels are still low. It makes me question WHY she’s having absorption issues though (which vet did not discuss).

In searching on these forums I came across a thread about another user’s Ulcer journey in which she did a video diary of her horse’s treatment. The week 3 video is EXACTLY how my mare moves on the lunge right now (link here) and her horse’s behavior in the stall from week 1 is pretty much exactly how mare is too (link here). Obviously not definitive - but this really makes me lean ulcers (and feel terrible because it likely would mean she’s had low grade ulcers for a while)

[joiedevie99]

FWIW, when my horse was low he was put on 10,000 iu liquid per day for 3 months before a re-test.

[gailbyrd]

It depends on the type of Vit E. There are different isoforms and you need to make sure you are giving the correct isoform for horses.

https://thehorse.com/172194/how-to-effectively-supplement-horses-with-vitamin-e/#:~:text=Vitamin%20E%20is%20an%20essential,preserved%20forages%20(think%20hay).

Another thing to look for is EPM if you are in an area where EPM is endemic.

[EventingMaff]

This article is super helpful - thank you. It has a comment about low absorption potentially being due to gastro-inflammation, which brings me round to ulcers yet again. It’s seeming more and more that ulcers are at play which is also causing secondary effects on Vit E levels (and therefore muscular stiffness).

Thanks all - picture is getting clearer in my mind and I’m really looking forward to hopefully confirming all this with scoping in the next week or so!

[Critter]

If you are thinking ortho/pain then SI is definitely worth investigating. I had a gelding suddenly start getting fussy in the contact and then got very backed off the leg. Then it went to bucking/cow kicking when you put leg on. He would walk on the buckle, but otherwise became very difficult. We did tons of tests (incl bone scan) and nothing conclusive came up. He was never really lame, but he could get a bit crooked/uneven. We finally conclusively diagnosed it as SI when we did a rectal ultrasound to look at the underside of the SI joint…turns out we found significant nerve root inflammation and remodeling. We did injections and gabapentin for a year (was trying to keep his core strong)…then the injections stopped working. He was coming 6 when the issues started. I ended up deciding to do “Dr. Green” as I was told his prognosis was poor - if lucky I would get a trail horse. I decided not to give up on him (at least we knew the diagnosis). I weaned him off all meds and just turned him out (he still came in at night). The first 2-3 months, he hardly moved in the turnout, he was in a lot of discomfort being off meds. I actually had decided I would give him 1 more month and then we would euthanize. By the end of the month he was moving around…then next month he would trot a little. The next month he was rolling. After 6 months he was bucking in play. I turned him out 14 months as I wanted to be certain I would never question if he had enough time off. I then did a nearly 2 year rehab process. We literally only walked under tack for 2 months. Another month with only 2 laps trot each way, etc. I followed a super strict back to work plan. He was almost 9 when I started him back. He is now turning 16…and he has been back to competing at PSG/I1 for the past 3 years! We’ve not done any SI injections since he was 6 or 7. I am very careful about his warmup and he has some compensations and things you could see if you knew what to look for. But he can still pull off a 70% in the ring, so I am thrilled to be able to enjoy him as he is the easiest horse to be around and ride.

[IPEsq]

I’m late to this thread but your description of the canter and also her natural gait sounds 100% like the SI issues with my last horse (necropsy showed the SI was a primary issue not secondary to feet or anything else. And chronic). Injections totally stopped the bucking into and in canter.

But some of the other things sound a bit more neuro like neck issues or KS. My horse had neck issues also. And we usually wound up treating neck and SI at the same time. His whole back was also a wreck, but that was secondary to the other stuff.

It wouldn’t hurt to take some spine X-rays but I think SI would be a reasonable direction. FWIW, I did trans-rectal ultrasound on my guy and it didn’t show much at all. Certainly nothing to suggest what we saw on necropsy. But it did rule out disc disease. We did have to keep injecting the SI.

[SolarFlare]

@EventingMaff

Hind legs, particularly left, swinging out and around at trot

Mine has had a primary SI injury (soft tissue), and swinging the hind left was one of the symptoms (I described it as “like an eggbeater”). I also recommend looking into that further.

[EventingMaff]

Thanks Solarflare - she’s done it since purchase as a barely broke 3 year old and it does decrease when fit but has definitely reared it’s head in these last weeks (and more noticeably in LH). How did you diagnose the primary SI soft tissue injury?

[SolarFlare]

We started off by blocking from foot to stifle (took two appointments because that’s a lot of carbocaine!).Nothing blocked sound. Make sure you also block the high suspensory, as apparently his symptoms also led two vets to think it may be that (but wasn’t in this case).

My vet had a flexion that could help test “high hind” issues, but couldn’t distinguish between SI and pelvis, and that did make it worse. We also tried a bute test (zero response, even with higher doses), and vet watched him lunge as well as me ride (looked worse with weight on him).

We did actually inject the SI based on those results, and saw a massive improvement, however it only lasted about 3 months, then we were right back to the start again.

We the xrayed the stifle (based on a second vet at the clinic’s observations) even though it didn’t block sound. A second vet wanted to block the high suspensory a second time (she was positive that was the issue) but still didn’t block sound. At that point we sent him for a bone scan instead of continuing to just shotgun more tests.

At the clinic, based on the bone scan results and looking at the diagnostics we had already done, they were confident it was soft tissue SI injury, and sent me home with a rehab plan (stall rest first).

That was in 2015 - I did a full, conservative rehab and he didn’t need anything else for the SI until 2019, when we injected again as it was starting to bother him a bit. He’s also now on a regular chiro/bodywork program which seems to be helping him a lot.

[IPEsq]

Depending on the soft tissue structures, you might be able to see soft tissue injury on ultrasound. The dorsal SI ligaments would be the most common (the ones that create the hunter’s bump), and those you can see from ultrasound.

[RhythmNCruise]

This turned out to be exactly the case with my guy. He went from laid back, practically bombproof, to a complete basket case. His back was tense and tender, he was getting the “hunter bump” deal, and he was just overall miserable. Chiro and saddle fitting (and eventually a new saddle) and nutritional changes (including magnesium at chiro/vet’s suggestion) were all addressed, but it wasn’t until I finally relented and said goodbye to my farrier of 30 years (!) to give the barefoot trimmer at the new barn a try that the final and most effective piece of the puzzle slid into place.

My horse, who couldn’t stand the slightest pressure down his back, especially lower back, and over his hips, is once again enjoying having his back curried and brushed, and loves his little “tummy tuck, and butt scoot” exercises. His topline is filling out, his hunter’s bump is much less pronounced, and he’s no longer jumping out of his skin at his own shadow (my theory is his pain made him more reactive because he felt compromised).

I still keep him on the magnesium and I think he much prefers his new (lighter) saddle too. But the hind feet were the root of all the trouble.

[skipollo]

I do the tummy tuck and butt scoot exercises daily too I supplement with magnesium–I also give him vitamin E during non-grazing months, that’s supposed to help with muscle stiffness/soreness as well. It’s amazing how small changes can make or break them with their feet. If I let my horse go past seven weeks, he starts to feel icky behind–not lame but just not great. He’s much happier on a six week schedule.