Sad update: Possibly neurologic? Etiquette with persistent old lameness and new lamness

Update: Thank you everyone for your gracious replies. The outcome was sadly, quite unexpected. As several of you suggested, I did ask for a referral to our local teaching hospital, and it went great. Everyone was very understanding. While waiting, my horse deteriorated to the point where the farrier was concerned and reached out. He noted difficulty standing on the left hind leg, a strange rocking motion to the front feet, and the left hind sinking. When I reported this to my vet, he was able to fit us in the following week in a cancellation spot.

Unfortunately, the appointment was soul crushing. My horse almost sat on the poor vet during flexions, and looked about to collapse. We both could see how hard he was trying to stay upright. The same original severe lameness was present on the left hind, though worse. There was trouble traveling in trot in a straight line (no issue on circles), tripping, and when asked to canter (his best gait) he would canter almost in place like a pogo stick and swap leads, or bunny-hop. Vet thought at this point he must have a broken hip or pelvis, and said I should just take him for a bone scan due to the severity. But then as we walked up the hill, he noted an abnormal gait behind. Upon entering the barn, vet also noted his odd stance. He was holding his leg in front and off to the side, and tilting a bit. He was been doing this for quite a few weeks as I think I’ve written about, but I thought he was just resting the injured limb. He also noted muscle wasting on the left, and asked if I noticed behavioral changes. I explained he was more panicky and spooky, but it wasn’t consistent. For example, we had to sedate him 2x for the farrier, but he was perfect the other times. I personally suspected ulcers for a while now, so kind of attributed the behavior to that anyway. At that point, he said forget the bone scan-he looks neurologic. He said he suspects EPM as his prime candidate, as the symptoms have been coming and going to varying degrees, and the issues are all primarily on the left. However, the other potential diagnoses are neuro Lyme, Wobblers, and EDM. He did neck rads, a spinal tap, a ultrasound of the pelvis and hip region ( to see if he could see anything that might warrant the bone scan after all) and took blood for Lyme. I already did vit E with spring shots and while on the low end of normal, I was told it wasn’t a cause for huge concern. Aside from possible narrowing channels in the neck, vet didn’t think wobblers as there was no associated arthritis. He is sending the radiographs out to a specialist anyway.

I am so devastated. My fear is all tests coming back negative, and not knowing where to go. I cannot afford a bone scan after all the diagnostics recently done, but I am paranoid we are missing something else, like maybe a weird SI injury or stifle injury. He has already been on rest for quite a while, and has been getting worse, so letting him decompress from his already low-key life seems like it would be fruitless, if it doesn’t result in even more injuries.

The reality is, unless this is something that can respond to treatment (in which the last of my money would be spent on that), I feel like this is both a safety issue and a quality of life issue. He is currently unsafe to handle behind due to the collapsing, has become reactive with the farrier to the point of sedation (which I wouldn’t want to do with a neurologic horse moving forward anyway,) is likely falling and having faulty proprioception evidenced by the constant pulling of shoes and injuries aside from the recent weird hind-end issue, and all of this has gotten worse with time off. I wouldn’t even feel okay retiring him to a beautiful field of grass at this point or to my backyard at this point because someone still needs to handle him. It also doesn’t rule out him falling on another horse, getting more injuries, or crashing through a fence.

I guess I don’t know what my point really is. I could really use any kind words. Insight. Opinions. Stories. Anything. I am just so darn sad.

Thanks for reading.

Hello everyone,

I am looking for some advice as to how I should handle my horse’s current situation. I’ve posted about him before, but I will give a run-down regarding what has been going on, and it is rather long. In October, my 5 year old gelding started with a right front lameness, that ended up with an MRI in January after several visits and various different diagnostics from our big-time lameness specialist. My horse was not in work at the time and lived outside 24/7 with access to a stall. He was diagnosed with an enlarged DDFT and some other minor abnormalities. Vet thought if he was put in eggbar shoes with a wedge and receive some time off, he will heal completely. Upon recheck in February, he was 100% sound. I was told I could start riding again at this point. I rode at the walk only for about 3 weeks, but my horse broke into a trot on one of the rides. He felt lame, so I got a video. He was VERY lame on his left hind. It was so bad, the vet thought he might have broken his coffin bone (I wasn’t told his level of concern until afterwards). When I tried to get said vet out, I was told he was booked out for 5 weeks, but I could truck in, which I did, the following week. The exam pinpointed the lameness to the left hind hoof, and x-rays showed a giant subsolar bruise. I was told to give him a week off and resume riding, if he was sound. I ended up giving him 2 weeks off, and he is still lame, though quite improved. However, I’m really worried. He never rests his right hind, is constantly resting that left hind. Sometimes he even holds it forward and off to the side. When I pick his feet, he acts like he can’t get back onto his right hind fast enough, and immediately rests his left hind, though doesn’t seem perturbed while I’m actually holding up the right hind. Most concerning of all, I have seen that left leg, for lack of better terminology, buckle. My vet can’t get out for another almost 5 weeks. He does not feel like this is an emergency, but I feel like there is more going on that just some giant subsolar bruise, especially given that his lameness is on the outside when being lunged (indicating soft tissue.)

If you’ve stayed with me this far, my question is ultimately, should I just take him to our local teaching hospital, request a second opinion with another local lameness vet (without the same excellent reputation) or wait it out for our normal lameness specialist to come out? I feel like these 5 week waits with little bit of diagnostics here and there are not only killing me financially ($160 farm call alone), but are not in my horse’s best interest as far as his long-term prognosis. This same vet used to do a battery of diagnostics if I requested, and a thorough, 2 or 3 hour lameness exam. Now I feel like I have to be really aggressive to get the diagnostics I want and he is very hurried. For reference, the DDFT issue wasn’t caught until the 3rd visit, after I insisted on an ultrasound. I don’t know that the etiquette would be as far as handling taking my horse elsewhere, without burning bridges, since I use this practice for everything else. Maybe these waits are normal and I am just being impatient. I’m really lost and have been losing sleep. Does anybody have an words of wisdom or guidance for me? Thanks so much!

If this were me, I’d get him ASAP to the local teaching hospital which hopefully will have a full array of diagnostic resources,. Five weeks is far too long to wait for a diagnosis/second opinion. You have to be your horse’s advocate. You need answers so you know how best to manage his care.

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I agree, depending on location, there are teaching hospitals with around the clock care and a huge variety of testing and treatment options. I live in Michigan and would be calling my regular vet for a referral to Michigan State University.

5 weeks is a really long wait for what you suspect is an undiagnosed lameness.

My guy had a really bad stone bruise last spring. So bad the vet thought he had fractured coffin bone from the way he was acting. It did not take that long to heal. So in my sample size of one, I think you’re right to question it after a couple weeks.

I don’t think most vets would hold it against you not to wait 5 weeks on a lame horse.

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Etiquette is to either ask your vet directly for a referral to the university or just make the appointment yourself. You can request his medical record/images be sent directly to the university. There’s nothing wrong with asking for a personal copy, of course, but every veterinarian knows that clients who do this are planning to use another veterinarian because they are dissatisfied in some way. Most vets are pretty philosophical about these things, but obviously some do get butt hurt about it.

Since you do want to continue to use this practice in the future, asking for referral or getting records sent directly will increase transparency, if that makes sense. No one is going to be mad if go the university/referral center. That’s different than going to another local practitioner aka the competition, if that makes sense. If possible, get message to vet about the decision/appointment and that you will be listing him as the primary dvm. Do this so the university will communicate with him about the case with the expectation that he will be part of the ongoing case/follow care.

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Tell the vet you are planning to go to the teaching hospital. Make an appointment and have his records sent there. 5 weeks is much too long of a wait. My regular vet (who is also an excellent lameness specialist that many other vets refer patients to for second opinions/diagnostics) has never left me waiting more than a week, and even that was only with my agreement that it could wait.

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If I was in this situation, my vet wouldn’t make me wait 5 weeks. Period. In fact, if my vet told me it would take 5 weeks for me to get an appointment I would presume said vet no longer wanted to be my vet.

However, I understand that my vet is not your vet and situations may vary. I think a polite and sensible approach would be “Hello Vet, Dobbin is acutely lame and I don’t believe it’s fair to him to wait 5 weeks to get him looked at. I understand you are extremely busy, so I’m planning to take him to the vet school pronto. Can you please make a referral for me and have his file sent to the vet school. Thanks so much”

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Update in the original post.

I’m so sorry it wasn’t better news. Thank you for updating.

I am so sorry you are going through this…sounds a bit like my gelding back in Feb. when I had to make the horrible decision to say goodbye. A year ago my then 4yo started with some stifle issues…we figured okay, he is young and huge (18h). Treated it, working on strengthening, etc. He seemed to improve. He also had a mild LF lameness, with nothing on xray and blocking wasn’t consistent. Tried shoe changes. We had some better weeks, some worse weeks…tendon strain/splint pop…never 100% good. By the fall he started to get very spooky and reactive…I first thought winter baby brain…then maybe supplement changes…then ulcers. But it was oddly inconsistent…sometimes nothing, other times an explosion (and he wasn’t that kind of horse). Full dosing of ulcergard, Mg supplement at a high dose…nothing helped. Even sedation wasn’t having the usual effect. He also got really tough for the farrier…as in the farrier (who is pretty patient) said he wasn’t doing hind shoes again. And my gelding had been one of the easiest to shoe since he was a yearling. That was when I really came to the conclusion there was something major. My vet watched him and thought he was starting to look neurologic (actually, it started out by making him even more impressive of a mover…he did extended trots in the field that were jaw-dropping). The behaviors/spooking got more and more bizarre and unpredictable, even in turnout…I had two under saddle explosions that my guardian angel did some serious work to save me…looking back I was really lucky I stayed on and didn’t get seriously injured.

Fast forward…we did all the work-up…he was neurologic but all the tests were negative. They diagnosed him as EDM. I made the decision not to bring him home and wait and see…he was already losing muscle tone and becoming more unpredictable. At almost 1600 lbs, it wasn’t a risk I wanted to take that he would get hurt or hurt me, even just being turned out. Plus, he was in pain and had been unhappy for a few weeks. I was watching him decline and I decided that wasn’t fair to him…especially with no treatment option (I can’t tell you how much I wanted it to be EPM…which sounds really strange, but at least would have meant we could try and treat).

The hardest part was waiting the 5 weeks to get the pathology report back. I was so afraid it would show nothing…then I would always question making the decision I did on a young horse. I sort of felt like I had given up on him during those weeks of waiting.

The pathology report confirmed EDM/NAD…he had bilateral brainstem axonal degeneration. At least I no longer have the guilt over the decision of euthanizing him. It still absolutely hurts and I miss him so much…and would have done anything to save him. But at least I know I had to make the decision I did…any other choice would have been unfair to him.

Sorry that was so long…and I wish I had a better story to share. Inconsistent lameness plus bizarre behaviors/spooking/reactiveness that is out of character is how the earliest stages of EDM presents…then they start to become more neurologic. But it can be a slow process…it is a lot like ALS or early onset dementia. Often people send horses out to trainers to try and fix the behavior issues…which can’t be fixed as it’s not a training issue…or get stuck with lameness issues that can’t seem to be resolved. Eventually it gets to the point where it becomes more obvious there is a neuro issue. Even talking to the research vets at UC Davis…they know very little about EDM, despite studying it for the past 10-15 years.

Editing to add…my horse started doing that strange rocking motion on his last farrier visit too…that’s when I knew we had a major issue.

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Oh my, I am so so sorry about your horse. Reading this sounds so very like mine. He’s recently started to seem miserable to me too. This horse is always the one that will leave his food for human interaction. Lately he’s been walking away from me in the paddock, which is honestly shocking. He’s the nosiest and most interactive horse I’ve ever had. I originally thought it was because he associated me with the vet (so many vet appointments lately,) farrier (since he’s been needing dorm gel,) or even deworming, but perhaps it’s part of a personality change.

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Yes, the personality change is part of the EDM presentation. Before my gelding was diagnosed, I talked to another person who posts on CoTH who had been through it with her horse. I think her horse had more pronounced personality changes than my guy…but my guy was also diagnosed much earlier.

My gelding had always been the most sweet and personable horse…the happiest horse I’ve owned and very social. He would have complete conversations with me and was always in my pockets, but you never had to worry about him nipping or being fresh. He was just absolute sweetness all the time.

The last month before he went to NBC, he got grumpy. He was still talking and social, but he would have his ears back (not pinned, but not forward)…which was never him. His facial expressions looked more stressed. Then, about a week before he went to NBC, he bit me…totally out of nowhere. I think he was as surprised as I was! He caught my finger and it was pretty bruised for a few days. He had never even been mouthy with me (even from a yearling).

We he was at the vet clinic we did a behavioral study just to make sure we weren’t missing anything. They said he was in pain and sleep deprived. So maybe that was part of his personality change…when I went to say goodbye, he was clearly not feeling well. If you use Facebook, there is a group that was started for EDM for people to share experiences.

I’m so sorry about the bad news.

You will know in your gut when you need to let him go. It’s never easy, but we have the responsibility to put aside our own wishes and make the decision that is kindest to the horse, heartbreaking though it may be.

Most of us have had to make “the” decision. It is very difficult, but when it comes to the point that the horse is unhappy, confused and in pain, we have to be good stewards and put the horse’s feelings before our own.

Sending sympathy and strength.

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