Peggy, did you just do 1 shot of IRAP each time or a series? I’ve been told it’s recommended to do for things like hocks in a series. I asked my vet about it for my guy’s neck and she’s a bit on the fence about it. Recommended steroids for the first round of injections just to be sure we hit the problem with the biggest punch we can. She also used a steroid that is better for high motion joints (not depomedrol). But, horse is only 5 so I’m sure he’s got more injections in his future as he has been declared negative on careful neuro evaluation so far and has been doing well so far going back to work. I know IRAP is expensive, but if it could be an effective alternative for long term joint health, then I would consider it. If you had to do it again, would you have still done IRAP or would you have done steroids?
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Peggy, did you just do 1 shot of IRAP each time or a series? I’ve been told it’s recommended to do for things like hocks in a series. I asked my vet about it for my guy’s neck and she’s a bit on the fence about it. Recommended steroids for the first round of injections just to be sure we hit the problem with the biggest punch we can. She also used a steroid that is better for high motion joints (not depomedrol). But, horse is only 5 so I’m sure he’s got more injections in his future as he has been declared negative on careful neuro evaluation so far and has been doing well so far going back to work. I know IRAP is expensive, but if it could be an effective alternative for long term joint health, then I would consider it. If you had to do it again, would you have still done IRAP or would you have done steroids?[/QUOTE]It was one shot, or rather multiple injections in the different facet joints on each side, but each injection site was done only once. We discussed using steroids a year later when he started tripping again but decided to use IRAP as it had worked well the first time. Or at least well in the sense that the tripping and other issues stopped, but not so well that I felt comfortable jumping.
I think that if I’d known that I would get one good flat-only year out of the first set of injections, followed by one meh year after the second set of injections, I might have just retired the horse at that point. But that decision would have involved crystal ball ownership. If I was in the same situation again I’d probably try the IRAP, depending on the vet’s recommendation. With the second horse I talked about that same vet did recommend steroids and that’s what we did. But I think she felt that his issue was related to an old injury and thus static as opposed to dynamic.
Got the radiologist report yesterday. I am not impressed with the utter lack of detail for $185. I have emailed the vet asking for the actual %. But here is the report:
"The facet process margins at C6 are irregular. There is mild proliferation on the dorsal margin. The processes are mildly enlarged at C5-6. The dorsal margin of the C6 caudal end plate is mildly proliferative. The intra-vertebral ratios are all greater than 50% but are marginal in the cranial measurement of C6.
Irregular margination of the facet processes of C5-6 and C6-7 indicate joint disease at these sites. This can have a variable influence on the spinal cord. There is no abnormalities identified on this study that would be compatible with spinal cord compression. If neurologic deficits are present then myelography may be considered to further evaluate the cervical spinal cord."
I’m not doing a myelogram. It will cost over $3k and the potential he doesn’t get up after… No. So that’s out.
Referring vet (vet#2) says he’s got arthritis in his neck. That was her summary of the report.
And now another wrench, I got a job offer back in Ontario that is a significant increase in pay for me ($10k+) but they want an early start date and my last day in Winnipeg is September 11th. Which means I have to make some kind of decision this week. And Monday is a long weekend, giving me only 6 business days left.
Because of THAT (moving almost a month earlier than I anticipated) I’m considering injecting the neck, hauling him home, and turning him out. Injections can be done while I am in Ontario in September and he will be hauled out in October.
I can see what I have in December and/or April and from there, take him to Equine Guelph as needed.
The other thing my vet has said is we threw a lot at him in a short period of time (shoes, hocks and fetlock injections). His back/body soreness may just need time at this point to resolve.
I can give him a year off back in Ontario. I can’t in Manitoba. Also, if we do euthanaize I can bury him in Ontario. Here, he gets dead stock removal and I’m 
about that.
Given my rush relocation stress, I don’t really know if I can make a 100% clear decision about him right now because of everything else on my mind.
Thoughts? Anyone else reading something in that report that I am not?
I would be inclined to do the neck injections and go from there. I agree with the vet that it will take some time for any soreness to resolve itself.
Good luck!
I think your plan sounds good. Better to take the time and be sure than rush and regret your decision. You have a lot on your plate right now!
Texting with my vet right now.
She says my options are inject or retire. I knew that.
She is hesitant on the success of reaching C7. She said she would just leave it alone unless I decide I want a riding horse.
I let her know I am fine with either a riding horse or a lawn ornament. I obviously prefer a walk/trot/canter flat horse but that’s not essential.
I also want him comfortable so if injections help with the comfort level, I’m apt to do that even if we still are only at lawn ornament level.
Given the report, I’d inject at least C5-6 bilateral. The thing is, it takes 14 days to have full effect, so hauling on the 12th would worry me.
I would be leaving on September 12th. Horse’s transport is anticipated between September 28 to October 9th.
Injections would happen in the next week or two to give enough time for it to settle in before the haul.
Oh, and do an ultrasound as well at C6-7 to see how much effusion is happening there. Ultrasound may change the vet’s mind about whether to try injecting there. Just because it’s not narrowing like cranial of C6 doesn’t mean the arthritis on the caudal side isn’t causing part of this problem.
That sounds like a reasonable plan. The time off after the injections may allow the medley of issues to cool off a bit, especially if there are referral issues. Then if he’s still off when you reevaluate after a couple of months you might be able get a better handle on things.
$185 does seem like a lot. My vet gave me the percentages and then got Barrie Grant to evaluate the radiographs gratis. But I already knew my vet is awesome.
Got a lot more detail from the radiologist.
"This radiographic study is challenging and I am sorry that you are in this position.
I took several different measurements of the ratio between the canal diameter and the vertebral height. This ratio when it is less than 50% is associated with increased risk for stenosis. In your horse, the ratio consistently measures above 50%. It measures 52% and 54 depending on which radiograph is measured. This is not published as an associated risk.
To complicate the matter, the facet joints which are associated with the intervertebral spaces do have evidence of bone proliferation and joint disease. The proliferation can be associated with canal narrowing but it is something we cannot measure using radiographs as it occurs in a dimension not visualized on radiographs.
In my concluding paragraphs I state that no abnormalities are compatible with compression. To clarify, I mean that no gross abnormalities are evident. It is possible that the facet joint disease is impacting the spinal cord, but unfortunately, this cannot be definitively diagnosed on regular radiographs. These radiographs do not rule out wobblers disease.
If there are significant neurologic deficits on clinical examination, and a treatable condition is not identified on routine diagnostic tests, this would meet criteria for AAEP guidelines for humane destruction based on the points of chronic and incurable disease and the horse being safety risk to himself and his handlers. These decisions are made primarily on the clinical examination in concert with the other diagnostic tests and as such should be discussed with the veterinarian examining the horse."
Thoughts/opinions? 52% was my cut off for hauling him home vs. euthanize.
I’m really sorry you’re in this situation. I had a VERY similar diagnosis on a lovely young OTTB I bought, passed the vetting and everything, but slowly started to go off on the right front, bone scan and follow up xrays found arthritis at C5/6, I injected, and was told “it will either work or it won’t”; it didn’t. He was 4. I gave him away, but honestly, I wish I would have put him down as I quickly lost contact with the woman I gave him to (this was before the days of FB) and I am extremely suspicous that he ended up in Canada, at least if I would have put him down I would have controlled his fate. Again, I’m very sorry.
Xrays only show so much. I would stick with your plan. Inject and move back with you. Retire him and enjoy the time you have with him.
Since there is so much uncertainty swirling around this, I think I agree with CAH above - inject, move him, and reevaluate afterwards. That way you are less likely to second guess yourself forevermore. And you might be pleasantly surprised at the injection results!
I would absolutely give the injection a try. I know a horse that got 5 good years out of once-yearly neck injections. You can always step up to the IRAP for a subsequent injection if the steroid/HA isn’t getting you the duration you hope for.
Inject, haul him home, and see what you have when you have a clear head.
OP, I very much understand what you are going through. I am lucky in that while my horse is borderline in measurements in some areas, he doesn’t seem to have that bony enlargement that is concerning your vet. My horse also was declared not to be outside the range of normal on the neuro scale for his conformation and breed. However, I am also dealing with some unknowns, namely, disc disease (narrowing of discs near the head), and there is just not enough research into what that means in a horse.
What helped me was to add more information than what you’ve got in that I also had a lameness expert do an ultrasound, and she consulted with a vet who had a lot of experience with spine imaging on ultrasound. These vets got together with my neuro specialist and radiologist. I spent a while with them going over all the images and measurements and their recommendations based on all of that information plus the physical exam.
With your guy having some neuro deficits, I understand your reluctance to do the myelogram (I’ve had good vets differ in opinion with one thinking its NBD and another thinking its a very big deal). I also get your sense of urgency with your move.
I would get that ultrasound done. While it still won’t tell you if there is compression in the dimension that we are concerned about, it will tell you how mad those joints are in terms of how much effusion is there. I think with a vet skilled in ultrasound of the area, you could decide a little better what the likelihood of success will be with injections.
If you get him to Ontario, is a standing CT available? We just got one near here at CSU and they wanted to use my horse in their evaluation stage (cheaper but not exactly free, and my insurance claim is closed, so it’s not going to happen right now). They would have to put the horse under general to image the neck properly, which is risky but a lot less risky than myelogram. It would allow you to really see everything bony going on in there if you have that available. But at the same time, by then you’d have injected and would know how that went and if it didn’t go well then maybe it’s not worth the expense of CT.
If you happen to have a COTH subscription there’s an interesting article on wobblers syndrome in the August 24 issue.
If you can, inject, haul him home safely and comfortably (make sure it is an air ride) and let him be for a year… There are enough good clinics and OVC who can really work on the dx and evaluate.
I am really jingling for you and your horses!! Glad to hear you had a job offer (at least financially, it will help!)
So, we are back to Vet #1 who is set to do the neck injections on Friday (the 11th).
I think I upset Vet #2 by doing my research and getting a second opinion on the xrays by Vet #1 but whatever. I sent my course of action to Vet #2 and I just got a very short “I don’t do those kinds of injections” via text and then was referred to Vet #1 for them. Maybe I stepped on some toes, but meh. I did also email the radiologist directly basically saying the report wasn’t good enough. So I guess I went over her head a few times. Or she maybe truly doesn’t do those injections. I’m moving in 3 days, so I won’t be dealing with either vet further it seems.
We are doing a bi-lateral injection of C5/C6 and we will be ultrasounding the neck (seeing as the needle needs guidance anyways). We may or may not do C6/C7 depending on what we find with ultrasound.
But, this is the last kick at the can - and I’m doing them here because I was quoted double in Ontario. So, getting them done, shipping him home, and seeing what I have in a month.
I am not getting my hopes up. I am emotionally drained by the he’s fine. Nope. He’s great now! Nope. He’s improved so much - he’s still NQR. He’s also borderline with the narrowing, so fingers crossed. I just want a purty lawn ornament at this point.
With no improvement, I will be keeping a constant watch on him and depending on how he progresses, we make the call when we need to.
Many good luck wishes for all of this. What a saga!
