SPIN OFF: Neck arthritis progosis

[Lord_Helpus]

Fascinating thread. Especially since most of the horses mentioned have cervical problems. Waldo “went bad” all of a sudden on 4/2, spent a week at NC State and has been at New Bolton for 5 days.

He has had multiple tests (spinal fluid and blood) for EPM and Lyme. All negative. But everyone was SURE it was EPM for ten days.

Hadveany of your horses been tested for EPM and/or Lyme before sighting in on cervical problems? The first week Waldo had neck x-rays and arthritis was found at the base of his cervical spine (C6 - C7?), but that was still ignored until the 3rd EPM/Lyme tests came back negative.

He is very ataxic and has no proprioception (sp?). He is a 4 on the 1 - 5 scale.

I have read that many of you had ‘neurologic’ issues, but were the horses ataxic?

Waldo is having a myelogram tomorrow morning. The vet said that if he had cervical instability, he could have surgery to correct it, but he would never be a jumper again. Other possibilities are cyst, tumor, blood clot, etc (all bad). If any of these are found, there is no surgery to help, so they will call me for permission to euthanize him while he is still under anesthesia.

I am in disbelief that all this is happening, but I guess that misery loves company… so I would love to hear if any of your horses were as ataxic as Waldo is. And if any of them had overnight onset of their symptoms.

The vets have never suggested injections into his vertebrae.

I am also noticing that many of your horses were treated by your primary vet while at home. Now I am wondering why my local vet insisted Waldo be ambulanced to NC State immediately. I did not feel comfortable with the vets at State, so I had him shipped to New Bolton. If you cannot trust New Bolton, who can you trust?

But now it seems like I am in for some big time procedures. I will be up to $10,000 in less than 2 weeks…

[joiedevie99]

Lord Helpus-

I had a mare that went acutely neurologic. Fine at lunch, couldn’t walk straight enough to get to the barn a few hours later.

We did DMSO and Marquis immediately, assuming EPM - but the test came back negative 3 days later. Over 5 or so days, she improved 90% on high dose steroids, and subsequently maintained at 90% for years (with occasional relapses immediately remedied with steroids).

Vet assumed tumor based on the response. I lost her several (good) years later to a massive internal rupture/bleed just shy of her 30th birthday.

[Lord_Helpus]

[QUOTE=joiedevie99;8621302]
Lord Helpus-

I had a mare that went acutely neurologic. Fine at lunch, couldn’t walk straight enough to get to the barn a few hours later.

We did DMSO and Marquis immediately, assuming EPM - but the test came back negative 3 days later. Over 5 or so days, she improved 90% on high dose steroids, and subsequently maintained at 90% for years (with occasional relapses immediately remedied with steroids).

Vet assumed tumor based on the response. I lost her several (good) years later to a massive internal rupture/bleed just shy of her 30th birthday.[/QUOTE]

Very interesting. The onset sounds identical, and the bute/steroids made him lots better for 2 days (Also was immediately put on Marquis). But when he went to NC State, they did not continue with steroids – just did Marquis and bute. No improvement after a week and blood/CSF came back neg for EPM. But they still thought it was EPM.

By the time EPM was finally ruled out, they did another dose of steroids, but, by then, it did no do any good…

I guess when I send him to one of the best vet centers in the US, I should expect that they will do every test they know – Hence the Myelogram tomorrow. If it does not show anything, I have no idea what the next plan is.

So glad your mare improved and was a happy, useful horse for years. That is my hope for Waldo.

[Peggy]

Both of my horses had a gradual onset. However, there was one interesting incident with Star (horse #1, now retired) while he was rehabbing from the first collateral ligament injury. At the time we did not know about the neck issues. He got some sort of a virus or something that was never diagnosed. The vet that was at the barn at the time did a multitude of tests, all of which came back negative. I was on vacation and thus not present, but several people who were there told me that Star was “scary neuro/ataxic” for roughly 12 hours. I now wonder if the combination of the narrowing due to the arthritis (that we didn’t know about yet) coupled with some sort of inflammation from the virus/whatever caused the neuro symptoms.

For Star, I also now think that something happened during or after the incident when he broke his jaw–struggling to get free, whatever they did to wire his jaw, and the recovery from the anesthesia–that further tweaked his neck as he was never really right after that. I did not know about the neck when he broke his jaw.

With Skipper (horse #2, euthanized on March 1, shortly after his seventh birthday due to a multitude of lameness issues and lack of soundness) I suspect that it was the combination of the stenosis (and cervical arthritis) and his pedal osteitis that made it impossible for him to get a balance so to speak. Although I didn’t do PPE neck radiographs, I suspect that the narrowing was there all along, probably something he was born with. So definitely not a sudden onset.

[Lord_Helpus]

For those of you who have done (or considered doing) the neck surgery, or any other kind of surgery to relieve the neuro symptoms, how much did it cost? (both surgery and lay-up and follow-up by the doctors?

[candico]

I knew two horses that had the surgery. The first was so sick afterward that they had to go back in and make sure they didn’t leave behind a sponge or ? He really wasn’t too bad on the neuro scale prior, just sudden difficulty half-passing one direction, and was okay to ride dressage afterward, but quite a long recovery. The second was boarded with me during recovery and even with pain meds seemed to be in horrendous discomfort for almost a month. He also became rather fearful whereas before he was not. Owner chose to donate him to a riding school eventually because he did not seem able to perform in dressage to her expectation and you could see he was still a bit wonky when playing in the turnout. The school kept the horse in a big pasture which I think did help him recover more. This horse also was not bad at all on the neuro scale - had been seen by two vets for odd lameness, stiffness issues, and only diagnosed neuro after going down to Dr. Grant.

Both were insured, not mine. So can’t help you out with the costs, but thought I’d share their stories. Based on what I saw, I would not put my horses through it, but have heard the odd story of horses doing quite well after. One horse who I think had two baskets where the vets boasted on how great the horse was doing because it was back jumping, failed to put down the landing gear one day after a jump at a show I think. People who saw it said it was pretty horrific.

Hope you have a more promising diagnosis. Neuro issues are so scary and heartbreaking.

[IPEsq]

If Waldo is a 4 on the neuro scale and the myelogram finds anything significant, I would opt to euth rather than do surgery. I do not believe the surgeries can make THAT much of a difference in improving symptoms. If he was not as high on the scale, my thoughts would be different. I have a horse with some arthritic changes in the neck and also an OCD at one cervical facet. He was declared WNL on the neuro exam, but I did have to consider all the possible scenarios as we went through the testing and imaging.

[Peggy]

My understanding is that the basket surgery will give an improvement of one on the neuro scale. So a 4 would go to 3 if that is the case.

Based on horses I’ve seen during the recovery and after and stories I’ve heard I would not do it. There is a poster on here who got a great result.

[Sancudo]

Sorry you are going through this, Lord Helpus.

Yesterday was two weeks post neck injections for my guy. Hopped on to see how he went under saddle. Absolutely no improvement. Would not turn right, would not trot. Farrier was out the day before, and even with sedation, we only got shoes on two feet. He can’t stand longer than a few seconds on three legs without needing to put the foot down. Prior to last shoeing, was a model candidate for the farrier- this flared up the same week the under saddle problems started. I’m so discouraged.

[ReSomething]

I cannot tell you precisely what happened to the old guy. I started out with a bad farrier visit, so bad that I thought the farrier had forgotten a foot entirely, they’d been getting longer and longer after trims, excuse after excuse, fired him, and while I was calling and waiting for a new trimmer, several days, he was walking slowly and pretty carefully, bear in mind he was almost 30 and stiff anyway. The new trimmer had to take off excessive hoof and I was told he would be sore from that, so it probably took most of my day to realize he wasn’t JUST slow and stiff, he wasn’t able to lower his head to drink or eat either. So at some point in there he had done something to his neck.
Initially I thought he had a stroke of some kind, then perhaps a sprain or worst a fracture. With his feet like that, he probably fell, we think at the Rubbermaid trough, landing on his throat and neck.
At 30, with Cushing’s, about all we could do was palliative care and Bute, or euth, and I kept hoping.
Dex is usually used, but not with Cushing’s. We did have an episode of ataxia so severe I called the emergency vet out for a euth but I just wasn’t clear enough regarding his symptoms, DH thought I would be upset with him if he didn’t do more, not a great time to be calling the on-call guy I had no relationship with. I ended up talking to my regular vet and making an appointment for several days later, but the old guy died on his own the night before he arrived.
Honestly, it was bad enough for the old guy I cannot imagine what it is like for those of you with a younger horse that now has a career ending injury.
Although he did die, I am of the belief that he had multiple issues of old age, previous colics and a choke, that combined with the neck issue and as a younger horse the prognosis to survive would have been high.

Unfortunately I can’t say to what end, pasture pet with limited mobility?
I just wish that I had made the call to have him put down as soon as I realized what had happened and that the feet no longer had anything to do with it.
I at least was realistically at the end of life for the old guy, hard as it was to let him go and as painful as it is. You all have my sympathy and best wishes as you navigate through these difficult decisions and I wish I had better knowledge of successful outcomes. Hugs to all of you.

[IPEsq]

[QUOTE=Sancudo;8622423]
Sorry you are going through this, Lord Helpus.

Yesterday was two weeks post neck injections for my guy. Hopped on to see how he went under saddle. Absolutely no improvement. Would not turn right, would not trot. Farrier was out the day before, and even with sedation, we only got shoes on two feet. He can’t stand longer than a few seconds on three legs without needing to put the foot down. Prior to last shoeing, was a model candidate for the farrier- this flared up the same week the under saddle problems started. I’m so discouraged.[/QUOTE]

Sorry, Sancudo. I was really hoping the injections would be the ticket for your guy.

[MuddyHalter]

LH, I hope you get some answers tomorrow. Here is a post I made on an earlier Wobblers thread.

I will share my experience with a myelogram and wobblers. My horse was 6 years old when he started to feel NQR behind and trip a little in front while foxhunting. When he went down on his knees walking down a hill (under tack), I phoned the vet from his back. He was normally sure-footed, so I was alarmed. He ended up at a clinic with a superb internist. After seemingly unremarkable cervical X-rays and a high titer for chronic lyme disease, we believed my horse was slightly neurologic from the chronic lyme. We treated for that (10 days of IV Oxytet and 2 months of minocycline) and the horse got the winter off. We had also done a spinal tap for EPM, which was negative. After the horse’s lyme titre came back negative that following spring and he was still not right, we opted to do the myelogram (there was a little more to the sequence of events and diagnostics, but it was several years ago, and a bit of a blur). The vets really expected to find something via the myelogram, and we were not planning to wake him up if they did; this horse was not one that was happy when not in work, and did fall in the field sometimes because he played so hard. The myelogram did not reveal the cause of my horse’s neuro deficits. The internist said that can happen if the compression is lateral vs. longitudinal (I believe I have that right). My boy woke up fine, but upon returning home, he couldn’t put his head down to eat grass. It was hard on both of us. Anti-inflammatories and some chiro and acupuncture got him eating again. We never did find out what was causing his ataxia, and I opted to euthanize despite my insurer’s refusal to pay out, because the horse was miserable and I felt he was a danger to himself (falling in the field) and was worried for my own safety. Both the internist and my regular vet supported that decision. So, I’m sorry I don’t have a better story for you, but I always feel it’s best to be armed with as much info as possible when making these decisions.

Also, regarding basket surgery, had my horse been a candidate, and had we flown in the specialist who is renowned for performing the surgery, I was told there was a 60 percent chance the horse would improve 1/2 a grade on the deficit scale. The surgery and recovery are supposed to be pretty tough, and given that my horse was a foxhunter and not suited to being a ring horse (he was extremely reactive in the ring - boredom, I assume - but bombproof as a foxhunter), I would not have opted for basket surgery. As another poster mentioned, we did the myelogram for the insurance company. Which, ironically, would have paid out approx. $15k for the surgery, but not the $10k insured value for euthanasia.

[teh_Kibbster]

Update

Hi all,

I only read page 3 - missed the request for an update on page 2. So here you go!

Horse has wintered well. He is about 50lbs lighter than I would like, however vet has recommended he be kept thinner due to arthrtis. She was happy with his weight given his myriad of issues.

Horse is currently barefoot (as I rode maybe twice this winter due to footing and no indoor arena). Deep, sucking mud has stripped his very expensive shoes twice, so I am leaving them off for now until the ground dries out. His R knee WILL “wobble” if he leans on it with his foot at a weird angle.

Hocks are ok. Not as stiff as they were, but not as great of a range of motion as back in September. I think this may be a lack of fitness. I will not inject these again (or the RF).

At most, I ride once per week now (given work schedules and commuting distance to horse). I am a walk/trot/canter on a hack rider. I expect round but nothing more than 1st level dressage. When/if he cannot manage this workload, he will be euthanized.

He had a check up from his Ontario vet April 1st. She did a neuro evaluation while writing his script for Previcox. He passed again.

She was concerned about his neck and RF xrays asking “is this horse sound”. Knock on wood, the only lameness we had is a hard, fast trot down a rough gravel road. His feet are tender and soft from the mud he is in right now, so I’m not surprised!

She is concerned about the neck xrays but declared him safe to ride (no neurological deficits noted during spring check up).

However, this vet is NOT a specialist and I don’t trust her opinion 100% as she also does cattle, etc. There are no horse specialists in this neck of the woods and she has limited neuro experience.

That said, I have noticed he stands with his front feet a little too close together lately. No stumbles. Tail pull test is very good, feet crossing is normal reaction times. This may just be me being paranoid.

His shots are due in June, so we will have another physical then.

I rode him on April 16th. No fireworks, he’s the kind you can leave for months. We had a walk, trot, canter through the field (100 acres are awesome). He was great - his laterals were also still there but rusty. The brakes still work too! :lol:

However, horse will not take left lead. You have to really, really ask to get that from him. He always will take the right when given the chance. Right lead has historically been his favourite. However, he hasn’t been ridden regularly for 4 months so maybe the buttons are rusty. He broke the left lead after 4-5 strides, trotted, then swapped for right. I did not push my luck.

All in all I still feel that the injections were worth it. I also feel some of his weirdness is also me seeing him for snapshots (3 hours, once per week). He has good days and bad days according to barn owner - sometimes he is stiff, other days he’s a 3 year old (although he was 10 in January).

However, I still stand by my decision that I will not repeat the neck injections. Yes, they helped. I do not regret doing them and getting him home to Ontario but research suggests it’s a one-time fix.

I will also not be hauling him to Equine Guelph for a complete work up as I planned. He does not travel well and he has limited handling by experienced horse people only (3 people - myself, barn owner, and farrier who is always supervised by barn owner). We all know his “normal” and when he progresses past this, we will make the decision. I won’t learn anything new from what they will tell me.

I hope that helps - if there are any specific questions you want answered, please let me know.

[teh_Kibbster]

Update

June 4 & 5 I was farm sitting. I was able to watch him for very extended periods of time. June 4th I ended up calling the vet. He was “head flipping” every few moments. Obviously uncomfortable.

Call the vet. Yay Saturday emergency call fees… We have to tranq him to look in his ears (he’s always been that guy). Dx of ear infection, Uniprim for 7 days.

He is now in his full face and ears fly mask, together with his Big D fly sheet in the event he is just a sensitive snowflake about bugs this year. He never was before. Shoes are back on due to stomping.

Vet out again on June 27th to do teeth, shots, and follow-up on his ear. Ear infection is “resolved”.

Since June 27th and today, I have ridden him once for 20 minutes. The head flipping, which I thought was a done-deal reared its ugly head again under saddle. We rode out with fly masks, etc. Tried different saddles (we have 2 that fit very well, dressage and a western) no luck.

I know the head flipping/ head shaking can be neuro sypmtoms. I’m out to see him again today.

Last time I saw him he was standing just a touch wider and braced out front, and slightly loosey-goosey behind. He just scrapes/toe drags again when backing up. I’m starting to get the feeling he’s done. He’s happy as a clam and is his big-dog self. However, I’m starting to see things that disappeared about a year ago now, and we just seem to be “slipping” in what was his new normal.

I’m debating having the vet out to re-xray the neck, see if it has progressed or if this is a lack of fitness. Or just retire him fully. I may unfortunately be “on par” with his euthanize in October/November 2016 timeline if this keeps going. :no:

I really hope we get one more good year out of him as a lawn ornament. He really deserves it, he’s been such a good soul. But if he is uncomfortable, we need to let him go. Thankfully his board right now is dirt cheap so I can afford to just turn him out if necessary.

[My_Two_Cents]

Thanks for the update. Jingles for comfort (yours and his).

[Weluvhaha]

I followed this thread because from the beginning he sounds just like my horse, and that’s not easy because my horse has a lot of medical problems. Neck arthritis, significant bone spur in neck, bilateral navicular, fusing right hock, sacroiliac joint disease.

I injected, he responded wonderfully until I began riding him and then he went steadily downhill. I stopped riding him. The vet #2 said to me, “He compensates for his problems, he’s managing, but if you add a rider, he just can’t compensate for that.” So I hope you retire him fully and enjoy your time together. I love seeing my guy and feel better knowing that I’m not one of the problems he has to manage.
Re: thin for arthritis. Well maybe but cold really hurts arthritis so you have to compensate for that.

[teh_Kibbster]

This horse has more coats that I do and our winters are now silly mild compared with Winnipeg :winkgrin:

Horse is maybe 50 lbs lighter than ideal. You can see his last few ribs. Front ribs you have to poke to feel. I’m not worried about his condition and the vets were very happy with him at both recent appointments.

I saw him this weekend and he’s over tracking and nipping his bellboots. I also crossed his legs again and there was no replacement for 20 seconds. He is officially retired.

[Gumby80]

Sorry to hear, but big ups to you for doing the right thing with regards to his comfort.

[teh_Kibbster]

New xrays - new prognosis

I had the vet out and re-xrayed the neck September 11, 2016. Vet who took images also did a physical and neuro test. Horse passed well within safe ranges.

Had his Winnipeg specialist look at the images to see if there were any major changes from last year who got back to me last night:

“The arthritis has progressed at C4-5 C5-6 C6-7. Based on the previous xrays there has been some advancement of the disease but overall I don’t see a lot of new bone growth compared to previous. The neurologic deficit from this arthritis are unlikely to cede, however, with management, they are hopefully manageable. I would recommend continued follow up on the neck and xays on a yearly basis to follow the progress of the arthritis or follow up xrays if the condition seems to worsen as in some cases, the swelling from the arthritis processes can result in increase compression on the spinal tracts.”

I have discovered Hal has not been getting is 10,000 IU of Vitamin E daily. There has been some miscommunication - his tub says 1/2 scoop A&P (am and pm) but he has only been getting a half-scoop daily. This is now resolved.

Hal has also not been getting his Cortaflex HA liquid (which Ontario vet recommends as well). This has gone back into his feed tub.

At his physical on September 11th we also upped his Previcox dosage - we were doing 5 days on, 2 off. He is now on 7 days a week. Vet and I agreed his comfort is more important that kidney function - he won’t be an old horse, so let’s just keep him safe and comfy.

Now since he has received all his meds, in their proper dosages, horse was fine last time I saw him.

Horse is also much better when working because he seems focused on HOW he moves, vs. pasture - where he is a, sloppy, “rangey” moving big goof. His ground-work is excellent. When he’s having a good arthritis day, general opinion and observation is you can ride. If he’s not having a good day, don’t ride.

Vet believes some of the toe-drag is farrier related (we are having some flaring). We are going back to the former farrier (who I believe was on mat. leave and unavailable). Vet also suggested weak stifles and poor trim balance for hind hoof pivot.

Since September 2015 there were some management changes and experiments, so we are back to his old Winnipeg routine as it seems he needs EVERYTHING to be managed.

But - horse is the picture of health and with the changes in the last 2-3 weeks, is back to his old self. So I don’t have to make THAT call yet.

[teh_Kibbster]

Since September post, horse has improved enough for us to consider moving him to an indoor for the winter to keep him in correct work and out of the mud that happens at he current facility.

I would also like him closer to me (I am 1.5 hours away right now) for the winter so I can see him more often. If we get a bad snowfall, no way am I hauling out to see him at that distance. I have found a place that will grain their outdoor horses twice daily and I think that is the best fit for him. I also already lesson at this barn.

New farrier + CONSISTENT meds = old horse.

Also, since the weather cooled off, barn owner commented he is much better. This may just coincide with the timing of the increased medication and better farrier, but I will take it!