SPIN OFF: Neck arthritis progosis

[teh_Kibbster]

Spin off from my neurological thread.
http://www.chronofhorse.com/forum/showthread.php?467268-COTH-opinion-neuro-issues-the-answer-page-5

Just wondering about the long term prognosis/soundness/safe-ness related to neck arthritis and injections.

Horse is 9. Unraced grey TB. Was started at 3 - given some time off due to another growth spurt. I purchased at 6 (2012), has been doing trails and training/first level dressage only until we had a fall November 2014.

Long story short, horse was collapsing in cross-ties on and off, dragging hind toes, pivoting hind walk. Had 1 fall with rider (resulting in broken arm/nerve damage). See original thread for more detail.

Horse has since been diagnosed with neurological deficit on the left side.

Horse has also been discovered in the last 4 months to have arthritic hocks and right front fetlock joint paired with navicular changes and narrowing on the right front. Horse is on and off lame on RF (no longer lame with specific shoes and pads). Horse also has “hunters bump” and almost always a sore back (no matter what we do). He has a heart murmur and suspicious looking potential melanoma (1 bump on lip, a suspect patch under tail). I have no 100% on a melanoma, neuro was more important in all our diagnosis.

Horse is currently on Previcox (was on bute), vitamin E 10,000 IU daily, Cortaflex.

I was just provided this opinion last night on the neck xrays:
“There is arthritis in several of the facet joints in the mid to lower neck (vertebra) with the worst at C5-C6 (base of the neck) and there is some narrowing at that space as well which is most likely due to the arthritis. There are a few areas of concern but I will leave the rest to the radiologist…”

I am waiting on the actual measurements from the radiologist re: the narrowing.

The kicker - I’m moving 22 hours away in October. I was anticipating hauling the horse with me to retire him and/or get him a bone scan in the spring but now I’m reconsidering. I’m working through a pro/con list right now regarding euthanasia.

Depending on the amount, severity, and % of the narrowing we will likely euthanize. If the narrowing isn’t bad, I’m not sure what to do. Heart wants to inject, get him home, and let him be a horse for as long as possible. Head says financially it’s silly to spend thousands hauling him home, then $400/month on all his needs for a 9 year old retiree.

Just wondering if the injections for neck arthritis have any long term benefits?

I’ve read old threads and the injections seem to work for a few months, then the next set nowhere near as long. They buy time, but that’s it. It will continue to progress. Personally, I don’t think it’s worth it, but maybe I’m missing all the good news threads?

Given his myriad of other issues, it’s looking like euthanasia but just looking for anyone else who may have experienced this same issue. Is there a light at the end of the tunnel for a horse that is relatively young, hasn’t been worked hard and is this arthritic?

I’m not sure how I feel about him potentially being on Previcox until he’s 30 either…

[Watermark_Farm]

Wow, with that laundry list of problems I’d certainly be considering euthanasia, too. And I’m one of those “keep them until they die” people. But it sounds like he just has the cards stacked way way way against him. Genes, use, injury, luck of the draw. Some things went very wrong with him somewhere along the line.

I had a horse diagnosed with changes C5-6 after struggling with mild hind end lameness and issues with swapping behind at the canter. He was graded a 3 on the neuro scale and I was told that injections would only improve him a grade, so he was not a candidate. He was retired to pasture and that went well enough, but he did not make it long term.

As hard as it is, when it’s issues coming from all sides, I think you will struggle uphill with this horse forever and spend money and wind up frustrated and resentful. No shame in throwing in the towel and putting him to sleep. I’m so sorry.

[IPEsq]

Prognosis is very individual. Depends on if there’s any spinal cord compression and where he falls on the neuro scale. Depends on how bad the arthritis is and if it progresses. We never really know, but the standard of care for neck arthritis is steroid use, and over time, steroids are bad for the joint health and they become less and less effective. Depends on when it and becomes clinical and what activity you want the horse to have. A good prognosis for your horse may be pasture sound retiree who is safe to himself and his handlers, from the ground. That would not be a good prognosis for say a 4yo jumping prospect. In any event, he is likely to continue to be expensive.

[MontysGal]

Hey there,

I don’t have any information to add, but I wanted to send you hugs, as it seems you’re doing all of the correct things and considering all of the options fairly.

Logically, a 9 year old retiree costing full board is never fun, but if he poses any risk even to a handler on the ground (you mentioned issues in cross ties, etc.) you have to take the staff and your own safety into consideration.

There are many worse options than being pts. I’m just glad your horse has such a contentious owner who is willing to review all options well ahead of being forced to make a decision.

[CAH]

I saw the other thread and the most recent news.

Had 17 year old TB that coliced badly. Found him in the field throwing himself to the ground. Got him to the hospital and into surgery, but was ataxic prior to going into surgery. Had a difficult time waking and getting up. When he came home he was weak and still looked ataxic to me. It took six months for me to build him back up before I put him into work. Little things were happening…one day he walked himself out of his shoes; one day he was cantering and just fell boom…went back to work but just wasn’t right.
Eleven months after surgery found him walking like a crab one morning. Definitely neuro that was diagnosed with xray. Injected the neck and spent three days in the hospital getting DMSO. Twelve hundred dollars later he came home. I think I rode him two or three times after that at the walk and trot…couldn’t trust him. His arthritis was minor to moderate in C-5 to C-7. Had another flare two months after initial injection and needed dmso again. Took him back six months later for more injections. Surgeon looked at me and said the E word. She injected him and sent him home…he was a 2.5 grade. Forty eight hours later he was found dead in this paddock. Looking back it was a blessing.

Here is what I learned. 1) It can be genetic in certain TB lines. 2) Sometimes the aggravating factor is an initial injury. In my case, I think he caused damage the day he coliced - whether in the field or waking up. 3) It doesn’t go away. You can keep it at bay, but it will only get worse. Cold weather doesn’t help. 4) A neuro horse can be a dangerous thing if handled by people that don’t know how to handle. That includes yanking on neck, etc. 5) At some point he will need NSAIDs almost daily.

I’m sorry. You might get a few years of happy pasture time with him and if that works for you, great. He is not a riding prospect and never will be.

[BoyleHeightsKid]

Wow… I’m so sorry you and your Ponee are going through this. Hugs for you and pats and scratches for him…

Hopefully the report from the radiologist will be able to help you make a decision.

[bettyk]

Man, Kibbster, I feel for you big time. I had a horse with arthritis in his neck and who also fell with me in canter and even once at the walk. Fortunately, neither of us were injured in the falls. I never went to injections, though–we tried some other things to make him more comfortable. After the fall in canter, we even tried just walking. But then he started not being able to get up in his stall, and it became obvious what we had to do. It was one of the worst days of my life as he was still as bright and personable as ever, but I loved him too much to let him suffer and we put him down. That was four years ago, and it still hurts. Your horse has so many issues that perhaps it would be kinder to let him go. I know that that’s your decision to make (and a difficult one at that)–but you’ll make the right decision, one way or the other.

[CHT]

The vibrations of the long trailer ride may be REALLY irritating to him if he has severe neck arthritis. I know my gelding (broke C2) is really bothered by trailering, so if I have to take him to the vet or something, I load him up on Dex which seems to help.

I do not think I would subject him (my horse) to a long trailer ride though, as I just don’t think he can balance as well as needed either. Something to consider for your horse too I imagine.

I haven’t bothered getting my guy injected, and likely won’t and would likely put him down if it got to the point he needed injections to stay comfortable in daily life. My vet said the only horses she does neck injections on are broodmares who need to be kept comfortable to maintain their foal, and she says they are typically done once a year.

Sorry your horse has all these issues at a young age, and that your move is meaning you need to make a decision quicker than you would prefer, but from what you wrote, euthanasia does sound like the more humane option for your horse’s sake.

[teh_Kibbster]

Thanks for the kind wishes and words all.

I just want to know what I can realistically expect when the vet #2 and/or radiologist comes back with yes there is arthritis (and the degree of the narrowing). I know they will likely offer injections if the narrowing isn’t severe.

Poor horse is probably feeling like a pin cushion about now. He’s been poked, prodded, and injected more in the last 4 months than the first 9 years of his life!

I think I’m going to euthanize.

It seems the injections just buy time (which we are already short on due to my move). The arthritis is irreversible and the fact that he is showing neuro symptoms isn’t winning any favours for a long term prognosis. He left hock never came right after the injections (the right improved by a mile).

When you add up all his issues, I don’t think it’s worth the risk and discomfort to haul him 22 hours (he hates trailers) to put him in a herd to sort out his pecking order AGAIN, to live outside full time in retirement (he’s been on indoor board the last 2 years).

Not to mention new farriers, new vets, etc.

I also don’t like the thought that he has to be on a low dose of pain killers forever. His body has failed him.

And he’s 9. He’s young and does stupid things. I don’t want him to fall in the pasture being a goof and get seriously hurt or paralyzed. That would be the worst way to go.

It’s sad and tragic, but I know it’s the right thing to do. I hope vet #1 (which is the only opinion I have on the xrays right now) just needs his eyes checked and my horse is a-ok but I’m preparing for the worst and hoping for the best. :no: I just don’t want to be blindsided and jump at the injections because they are offered if they aren’t shown to help much in the case of neck arthritis.

On the other hand, if I get him back to southern Ontario (only -30C winters, not -50C like Manitoba) he would have over 10 acres in a quiet herd that he was in before with a run-in to just live out his days and be a horse. He’s not strangers to this herd, which makes the risk less. But there is still a risk.

it’s 6 of one, half a dozen of the other. I’m impatiently waiting for the radiologist report.

[nu2u]

I have dealt with this…unfortunately the diagnosis of early arthritis in the neck of my 10yr old TB came too late…he had flipped while lunging…lasted 6 days before he had to be put to sleep. Xrays were taken immediately after the fall to see if he had injured his neck…vet could not express enough how it was a total accident, not my fault, not horse’s fault his neck just hit the wrong position and he got a jolt of shocking nerve pain, it could have been worse someone could have been on him. So you are right there are many worse ways for him to go than euthanasia…sorry you are in this situation, but glad he has someone strong and smart enough to do what is in his best interest.

[findeight]

I cannot believe it would be fair for either of you to dump another couple of thousand injecting him for a temporary improvement then put him in a trailer for a 22 hour haul. Not just because he will probably be scared by not having full control of his body and balance in the road. Because he has multiple other problems that require a painkiller.

He hurts. Do you want this to go on?

Allow him a dignified and peaceful passing on a warm fall day. Don’t force him to keep enduring what he cannot understand, that scares him when he loses control. Don’t force yourself to think you have to keep it up either. It’s perfectly reasonable to consider your finances when there will be no improvement and deterioration is likely.

I have some friends with older horses and we have all agreed we will tell each other if and when everybody sees its time but us. To prevent keeping them going for us when they should be allowed to rest for them.

[mroades]

hugs to you. I believe letting this horse go is the kindest thing.

[2tempe]

OP - Re the injections, here’s what I can tell you: In Florida it cost me $800 to get three facets injected bi-laterally (2011). Horse, who was just shy of 22 at the time, improved significantly, from being unrideable to a walk-trot-canter guy. Did very well for about two years, when his stifle began to slip out behind somewhat regularly. Quit riding and retired him. This summer, after almost 2 yrs as a pasture puff, the neuro signs now very clear - weak behind, a funny positioning of the front feet when he walks. No tripping.

I was lucky that he improved as much as he did, and for as long. Vets are satisfied with a 1 grade improvement in the neuro symptoms, more than that is not seen much I guess. I’ve been told that a second set is never as effective, and in some cases not effective at all.

Its a crap shoot. The transport will be hard. If you have other lameness issues, it complicates the scenario. So does winter. I wouldn’t worry much about the murmur.
There’s nothing wrong with giving him another month of two of enjoying life as much as he can. Load him up on pain meds to make him as comfortable as you can in the meantime.

Hugs.

[Simkie]

FWIW, I moved my mare with C6/C7 arthritis to MN about a year ago from CO.

She was transported in a stall and a half in an air ride, and she was very tired when she arrived. I should have done a box stall for her.

Mine is very slightly neuro, and not in pain, as far as we can tell. She’s a princess and doesn’t have a stoic bone in her body, so she’s certainly the type to tell us. The extent of her neuro “disability” is that she swings unevenly from behind, and she’s a little odd about holding her hind feet up for the farrier. It’s pretty clear that she doesn’t quite know where her hind legs are in space.

We injected her when all this started, and I got an AWESOME six months. We did her neck again when the first set wore off, and I got a few weeks. I retired her at that point. She has not progressed. She is very happy in the field.

I don’t think you would be wrong at all to euthanise at this point, but if you’d like to try injections and shipping him, I would absolutely advise a box stall on an air ride.

[Peggy]

I have heard good and bad neck stories. Good as in horse is jumping around at >3’6" with periodic neck injections and bad as in neuro symptoms worsened rapidly and they had to euthanize. IMHO it is one of those “it depends” scenarios. How bad it is when you find it. Are you talking arthritis or just narrowing or a traumatic injury. Where it is. Where the horse is on the neuro scale. The nature of the horse.

In your horse’s case, with the medley of symptoms including the falling, I’d be less inclined to try injections than I would with a horse that had narrowing but few to no symptoms. I don’t think that euthanasia is at all unreasonable.

I had one with arthritis at C-5/6/7 that was tripping and lame (stabby more than lame, at least until he re-injured the collateral ligament). Passed neuro exam until the point when we tried to blindfold him and he wouldn’t tolerate it, so we don’t really know. Injected neck with IRAP, brought back into work and had a pretty good flat year only. Re-injected neck with IRAP a year later and had a meh year. Retired horse due to that, GI issues, and apparent general unhappiness in work.

What CHT wrote about the horse getting worse after colic surgery is interesting, because this horse seemed to develop the issues that we eventually figured out were due to the neck more rapidly after he broke his jaw and had to have surgery. I don’t know if it was getting his jaw stuck and the struggle or whatever they do with they bring them into surgery or the recovery, but I really think something happened in there someplace to exacerbate things.

I gave another one a year off, with the idea that if his undiagnosable lameness issues did not resolve I would euthanize him. He had borderline narrowing in the neck and was fine with the neuro test until the blindfolding part, when he did the hyperextemia thing with the front limbs. Vet pronounced him maybe 0.5 on neuro scale and gave him a sort-of OK prognosis, given the neck and issues in two limbs that seemed fixable. We did neck injections and started rehab. Roughly 6 months later as we were starting to trot under saddle, he became undiagnosably lame on a third limb and it was at that point that I gave him the year off. In his case, it seems to have worked, at least so far.

[teh_Kibbster]

To be fair, the falls only occurred while tightening a girth in cross-ties.

We had one fall going downhill in “questionable weather and footing”. Albeit, I still don’t know why he fell. It was only -6C that day, less than 1 inch dusting of snow. No ice on the ground, had done that trail hundreds of times before. That’s the only FOR SERIOUS fall. For all we know it was a bad step and the ground wasn’t fully frozen so the dirt crumbled, etc.

I also know it only takes ONE fall to kill you.

Horse is trippy under saddle. Knocks hooves against ground poles, gates, etc. Does toe-drag. His back-up is atrocious.

Horse has never just been wandering around the pasture and fell. I do not consider him dangerous on the ground. I cannot trust him 100% under saddle. Horse seems very happy just being a horse and we have the lameness resolved given his special shoes and hock injections. His left hock is not 100% but pasture sound? For sure.

Obviously this is an it-depends. The degree of narrowing will be the settling factor. I only have 1 vet’s opinion right now - and he’s not even on my payroll!

I don’t begrudge the money - $400/month on a retiree isn’t the end of the world. But it is a factor - like all the other things he has going on. The trailer ride is another factor. That he’s been on indoor board for 2 years and would be retired in a 24/7 turnout situation… many, many factors. Lots of pros and cons to each situation.

Horse would go to a closed herd on a private farm owned by a family friend. Limited handling. Just a lawn ornament to get loved up on. If we had never moved from Ontario, I would just retire him there (provided the narrowing wasn’t severe) and when/if he got worse, we would end it. In 6 months or 6 years. Whatever he needed. Euthanasia is really being discussed because I am moving.

I’m just wanting experience and opinions from objective outsiders. I don’t want to make the decision while I’m being emotional and treatments are tossed on the table for me to snap up.

[CAH]

So here is a suggestion. You are moving in October. He is going to a closed herd. Start prepping for the move now. Neuro horses are hard to shoe - transition to bare feet if you possible can. I would not worry about the neck injections. See how he does the next four to six weeks. He could remain stable or go downhill quickly. If he remains stable than ship him in a box stall. You don’t want the neck tied up high for the trip.

He is probably better off out 24/7 but you need to look at the weather factor. Out, in snow, and cold. Will he be able to wear a heavy blanket and will he be checked daily? The last thing you want is a horse that is down and cant get up. Not fair to him.

You have a few weeks to make a decision. Take a deep breath and look at both sides.

[CAH]

Peggy - getting these guys on and off the table is difficult in of itself. The doctor told me they had difficulties with him waking up. I can only imagine how bad it was.

[Clair2014]

I’m so sorry to hear all this. I think I responded to your other post too but I just dealt with this kind of diagnosis with a 3 year-old earlier this year. His compression was at C5-C7 and he was already developing arthritis at his young age. Similar to your horse, he was falling under saddle and was not safe to ride. I did end up putting this horse down and it was a very difficult decision. He was still very vibrant but he had so many factors stacked against him and he was notorious for tripping and falling on his knees, amongst other things. What really made the decision for me was when the vet said “today is the best day he’ll ever have.” He meant that the horse would just keep getting worse and I guess I felt that a day too soon was better than a minute too late. I’m not saying you should put your horse down but I don’t think you would be wrong for doing so. It’s a hard choice that only you can make. Best wishes and jingles for you and your horse.

[horsepoor]

This thread is hitting close to home as I’m dealing with a 10 year old with neck arthritis that responded really well last year when we injected, but now, he’s suddenly gotten bad again. He has never fallen, but gets wobbly especially going down hills, toe drags behind, and knuckles over on his hind legs sometimes. I’m debating whether to do the neck injections again but this and other threads I’ve read has me discouraged. He’s IR/EMS so exercise is important for that as well, so keeping him going somewhat is not just for me to ride, but for his own health.

OP, I am thinking that I would euthanize if I were in a similar situation, but I also see that you are trying to make the best decision and thinking it through, so will support whatever you go with. Will be interesting to hear what the radiologist report that you are waiting on says.