Update p 75: OSPHOS timeline? Kissing spine and neck issues - a thread

[fivestrideline]

As some may remember, I have a 12 year old OTTB gelding who I have owned since he was 3. He’s been my Mr NQR for ~4 years or so, and peeling the onion has revealed kissing spines, a (now healed) front suspensory, wonky hoof angles that don’t want to improve easily, and now a bone spur in a fetlock with some bony changes as well as questionable field neck X-rays that are being sent to a specialist.

This horse has been (unwillingly) retired for a while, but I had the vet out because he’s become increasingly questionable neurologically in the front end. He does not want to uncross his fronts, rope walks downhill, etc. I basically said I’m worried about his QOL, both now and long term, and while I’m happy to retire him I’d also be thrilled to walk trot around on him by some miracle. Lyme and EPM blood tests came back as negative as they can be realistically, though the vet said there could still be EPM since the blood test isn’t the gold standard.

We put him on gabapentin and saw a HUGE improvement in his behavior, but his back is still sore and he’s still… weird. So the vet came out to do another neuro exam, some flexions, and neck X-rays. We could not see C6/C7, but C5/C6 does have some spots that are questionable enough to send the films off. I also chose to do a round of OSPHOS on their suggestion while we wait for the specialist since it may help his neck AND his back.

I basically told the vet that since I hadn’t done more than muscle relaxers and bute and PT, I am willing to try some things to get him comfortable but I’m not interested in a myelogram or surgery or anything like that.

I would love to hear any OSPHOS and injection stories for KS/neck issues specifically, but this thread is also just a catalogue of what I’m going through with this horse. I can’t maintain him on a hugely expensive routine, but I felt like trying a few things and seeing what happens, even if that is ultimately retirement or euth.

[Simkie]

I have a horse with arthritis at C6/C7. She presents fairly normally but unable to swing evenly from behind. She was diagnosed with bone scan followed by radiographs over a decade ago. We treated with steroid injection at C6/C7, which gave me six great months. When she went off again, we redid the neck and I got a couple weeks. I retired her then. When we were working to diagnose her in the beginning, she was really painful all over, and was diagnosed with neuro wind up, which was treated successfully with a few months of gabapentin, and that’s never repeated. I watch her very carefully and have not seen a decline in her condition, but do think that there will be a point in the future where she will decline, and I’ll euthanise then.

She was never as neuro as it sounds like your horse is, and after we resolved the wind up, she’s been happy and comfortable. She’s not at all stoic, so does make it clear when things aren’t right in her world, which is handy here.

You describe pretty intense neuro symptoms, and his behavioral stuff has sounded really concerning in your other threads. I’d sure be hesitant to keep going

[fivestrideline]

Yeah the OSPHOS and maybe a round of neck injections (not sure what) is kind of the last hurrah for him. The gabapentin took him from a hell hound to a decently happy citizen, and then the crossing of the front legs started. It does look like shoulder, maybe, but I’m awaiting the specialist on the neck.

I just wanted to try something more than muscle relaxers and see what happens. Maybe nothing. But at the least I have a vet who is seeing him and noting my concerns, and I did voice my concern about QOL.

Maybe I’ll see improvement, maybe nothing, who knows. I’m aware that necks are hard to really make a determination from X-rays, but I guess I just wanted to know if there’s anything glaring in there.

[Simkie]

@fivestrideline

I just wanted to try something more than muscle relaxers and see what happens. Maybe nothing. But at the least I have a vet who is seeing him and noting my concerns, and I did voice my concern about QOL.

I’m really glad you have a vet who’s really listening and engaged–I know how hard you had to work to find that! You’ve really advocated for this guy, and that’s great that he’s happier on the gabapentin. That does certainly point to neuro stuff as a big driver for him.

We got some additional info on my horse when we ultrasounded her neck for the injection. It is pretty dependent on operator’s experience, but if your vet has seen more than a few necks, that might give you another data point as you move forward. (And, hooray, ultrasound isn’t a gazillion dollars.)

I really hope you get some solid answers that help you to feel confident with whatever decisions you make. I know it’s just so tough.

[fivestrideline]

Thanks for your kind words. It really means a lot!

He’s a handsome guy and has been a Guinea pig for my horse ownership learning curve, being the first horse I ever bought for myself. Until he outpaces my wallet or says he’s done, I want to try a few things.

[Sdel]

We have twins! All the way down to the bone spur in the fetlock.

Honestly, my guy loves his chiropractor and looks tons better after each adjustment. He gets it bi-monthly and other than trying a fetlock injection going into winter, pain meds, and his stretching/PT routine I’m not planning on doing much more than that.

I may add acupuncture as well.

[fivestrideline]

Mine HATES chiro! That said, I should get him back on the bodyworker schedule. It was helping until he got so much worse, at which point I put that money towards vet bills.

I wish I had a PEMF machine as he loves that, but he needs it more than occasionally for it to do anything.

[Sdel]

Just an oddball question……do you give him routine electrolytes?

Mine struggled with muscles tightness all over last year. This year I really got aggressive with the electrolytes and he’s been much better.

[fivestrideline]

I don’t. Hmmmm.

He won’t touch his feed with even the tiniest amount of salt and he’s on two medications already . I have to coax him into eating anything new, so I haven’t tried anything like electrolytes. But it’s not a bad idea, if I can get them into him.

[awaywego]

I’ve been doing Osphos shots on my 18 year old approximately once a year to 18 months for the past 4 years. He has pretty ugly kissing spines on radiograph, but as far as I know, no neck issues. We actually have him on the Osphos because he has pedal osteitis as well. I do think it has helped, but it’s hard to say if the Osphos helped his feet, which in turn helped his back. The only times I have ever seen him exhibit true back pain are: 1) Lyme disease, and 2) when his front feet hurt. For me, I file Osphos under “can’t hurt/might help” with all of it. Same as your guy - it’s a bit of a chicken and egg thing with all the issues - so it’s hard to know what really has helped. Many, many days I think I just can’t do it with him any more because the mental weight of all of it is just too much sometimes.

[fivestrideline]

@awaywego

Many, many days I think I just can’t do it with him any more because the mental weight of all of it is just too much sometimes.

Is yours retired?

I feel this. I take it day by day, but sometimes the thought of 10-15 more years of asking myself if he’s in pain or just sensitive (plus the money and logistics) is just exhausting. It’s not easy and I feel for you!

OSPHOS isn’t benign, but at this point this horse isn’t comfortable so I’m willing to risk some side effects. I just hope it helps him more than anything. The neck is just as likely to be within the normal range of spine anatomy, but who knows.

[awaywego]

@fivestrideline

Is yours retired?

It depends on the day what my answer is I spent a small fortune in injections this spring - coffin and knee - but haven’t really done much with him since then. At the time he was also doing a weird thing with his hocks - basically walking bow-legged in the back - and the vet suggested Gabapentin. Initially I was loving the Gabapentin - so lovely to ride! Then he got too dopey, to the point where I was like, ok, well maybe you ARE retired. So now he is back off the Gabapentin, no longer bow-legged, but spooking left and right - so now I’m thinking ulcers… and this is what I mean about it being all too much sometimes.

All of that being said, the horse is a show horse through and through. He gets in the ring and is just like SHOW ME THE JUMPS.

[fivestrideline]

That is weird. I’m sorry to hear about your struggles. It really saps the fun out of horses.

My horse is on 12 gabapentin twice a day, and even just bumping down to 10 gabapentin 2x daily turns him back into a spooky rage machine. He’s come off of it entirely twice due to ordering delays, and he goes back to crawling out of his skin - uncomfortable, angry, spooky. That’s what makes us think there’s a likely nerve issue vs “just” the kissing spine.

[slp2]

I am sorry you are going through this. I have a mare with neck issues. She was never neurologic—we tested multiple times at the vet school. Was so easy and lovely to ride at age 3-4. As she matured, her canter was just not developing under saddle. She could canter for a bit and then she would panic–almost as if there was a nerve that would get pinched. When she didn’t panic—she couldn’t maintain the canter, and if I pushed her on, she would swap behind.

We chased down many rabbit holes on diagnostics and found nothing. She was also a headshaker from age 4. She was on cyprhetadine for that and at one point we tried her on a course of dex for the headshaking. Amazingly—that was the best that mare ever felt. Cantering around pretty much normal. Vet / chiro I was working with at the time noted that and asked whether I had ever xrayed her neck. So back to the vet school we went. They found cervical arthritis—C5-6. We did a round of injections. Like Simkie - I got about 1 good year from the first injections. We tried injecting 2 more times—each time I got less out of the procedure. We also tried mesotherapy and some other modalities. Never tried gabapentin though. Anyway—when she was 9 I retired her because I felt like we kept trying things and she was not ever going to be comfortable as a riding horse. She always moves great at liberty and in the pasture so her QOL is good.

These puzzle horses are so frustrating though! Of all the horses I’ve had in my life (6 so far)----she was the only one that couldn’t be “made right” no matter what we tried. I have pondered about ECVM and some of neck and back abnormalities they are finding recently . Those might not show up on x-ray or bone scans but are found in dissection post mortem. Or maybe it is just a nerve impingement that is triggered by the movement of the neck in the canter. Either way, its mentally taxing to keep trying to “fix them” so I completely understand your dilemna!

[awaywego]

@fivestrideline

That is weird. I’m sorry to hear about your struggles. It really saps the fun out of horses.

Haha, when we were seeing the sports med vet this spring, he actually said to me something along the lines of “no offense, but medically speaking, your horse is very unusual.” Mine has a very weird tremor in his front leg that a couple of vets have diagnosed as front limb shivers, and that was partly why we tried the gabapentin as well. That tends to come and go a bit, so I’m not exactly sure it helped and am waiting to see if that returns. I was really hoping that the gabapentin would be the turning point to get him to lie down finally, but no such luck.

Sorry that you have a weird one too. I can completely understand why you retired him.

It’s hard to believe it was only 20ish years ago that diagnosing ulcers was still a new thing. I look back on my horse who was diagnosed then after what was likely a lifetime struggle, and think about all the ways he probably suffered. It’s possible in 20 years, I’ll be looking back and thinking similarly about my current horse. It’s hard, but we can only do the best we can in the moment with the knowledge and resources available.

[IPEsq]

Osphos can help a lot with bone pain. So it may help the KS component. While those effects are very quick, IIRC they don’t last a real long time. As the main reason for Osphos is to help with bone metabolism issues in the longer term. I would be hesitant to use it in a situation where the horse is already laying down too much bone somewhere.

If the horse is experiencing neuro deficits, that is likely not a bone pain problem. It can be inflammation in the joints and nerve roots. It can be dynamic compression of the spinal cord under certain conditions (such as posture going up and down hills, different head positions, etc.). Steroids may help with the inflammatory component, but nothing other than the various surgical cases can potentially fix the spinal cord problems. Of course there are a number of problems that can cause the impingement. ECVM abnormalities (also common in TBs), tumors, disc disease, severe arthritis and other age related changes causing stenosis. Some of these answers you can only get with myelogram. Others you may want to go to a clinic for a higher powered xray and radiology team that knows the right views to take.

In my experience, the more noticeable the neuro problems become before you start treating, the more likely steroids and such will not provide great results. Especially in a teenage or older horse with multiple spine issues, and especially if they have lower neck instability from a higher grade of ECVM or a past serious trauma like a fracture. But our understanding of neck issues and treatment techniques are always evolving, so maybe if you can see enough on X-rays to develop the right treatment plan, you might get some improvement with steroid injections. You will also need to keep up with bodywork (PEMF is great but if it’s a bigger machine like Pulse or MagnaWave, do NOT turn it high enough you get noticeable twitching on the neck with a horse like this), farriery, and working on his proprioception through movement. It’s really a lifestyle managing these horses. Which can be a lot of work and if he doesn’t get significant relief through the meds, it does become a QOL question. And every horse is very individual in how the issues affect them from a pain and movement perspective. Some may seem “worse” symptomatically or on imaging but manage a lot better than others. And some can stay mildly NQR for a long time while others can deteriorate somewhat rapidly.

[NaturallyHappy]

You reminded me of something when you mentioned bone pain…one of our vets prescribes meloxicam for bone pain. That might be something to try.

[fivestrideline]

@IPEsq

It can be inflammation in the joints and nerve roots.

That’s some interesting info to mull over, thanks!

We definitely think the front end neuro symptoms are nerve related, based on the gabapentin response and some other factors. The OSPHOS was for the back (it’s very symptomatic), but we figure if the neck has a bone issue it’ll help there too.

This horse basically won’t uncross his front legs if you set them down crossed, he just stands there. He rope walks in front downhill, worse with the head up, but no perceptible change with a blindfold on. He’s trippy, big time, in front, and just seems to plow through stuff.

As I said, I want to get him comfortable, but the back pain really doesn’t want to respond as I hoped. I’m not sure it’s fair to him if he looks sound running around but a finger down his back has him buckling. That tells me it hurts 24/7 and is my biggest QOL concern, followed by the neuro deficiencies.

This is likely delaying the inevitable but some part of me wants to try everything I can first - at least then if I have to make some hard calls I have the working relationship with the vet to say “he’s had enough”.

ETA: I may have mentioned it before but we also started prednisolone last night, for 3 weeks. TBD on if it helps

[IPEsq]

You aren’t going to want to try injections while you are doing a Pred trial. But if the Pred doesn’t help, that doesn’t necessarily mean targeted steroids won’t help in the neck.

I think unless you can correct his movement and other postural issues which may be coming from the neck (and not helped by the feet, but how he loads his feet due to pain and neuro stuff also an issue), you won’t get anywhere with the back pain.

[LadyB]

Mine also absolutely HATES Chiro. He gets Craniosacral Massage about every 2-3 months, and then basic massages in between.

He’s 21, I’ve had him since he was 3 and has KS. 2 (maybe three now?) I injected his back with Cortisone, and did Mesotherapy (game changer!). Every horse is different, every case is different and every horse reacts differently to treatments.

I joined a FB group called ‘Horses with Kissing Spine’ and although its not veterinary advice, its a bunch of owners who have done every type of therapy out there with all different results, its a handy group.

I cannot add much to any of your neck issues, but I have definitely been through the KS experience and have found the best maintenance that works for my horse.

What is the degree of your horses KS?