What test should I be asking for? At a loss

[Mistys_Girl]

I don’t know what to do. I have a 17 y/o tb mare with trauma. We have come so far, yet feel like we are not making much progress.
She came to me with a body scale of 2, she’s not a great eater. After lots of GastroGuard, we went grain free and that seemed to help her gain and settle.
She’s had narcolepsy the whole 18 months I’ve had her. Due to getting callous on he fetlocks she wears quick wraps at night. Vet feels it’s a pain induced narcolepsy due to the way she reacts to tranq.
She’s come in shaking like she’s cold, yet she’s snug as a bug in her blankets. She settles out of the shaking, but it comes on for no reason. She’s body sore, nasty to groom, even with work has issues cantering. She can’t hold the canter, and cross fires.
Vet is coming tomorrow. Looking for ideas of tests to ask for. Lyme? EPM? PSSM?
This girl has a home with me for life, just want to make her comfortable. She’s the best hack horse I’ve ever had.
She gets regular osteo treatments. She didn’t like massage or chiro. Touch and stimulation is hard for her.

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[joiedevie99]

I feel for you. These situations can be so hard. It seems like she’s got a lot going on - and there may be more than one thing behind all this. I’d certainly want to rule out EPM and Lyme because they are blood tests that are easy on her.

I’d also be trying to narrow down whether she is actually narcoleptic or whether she is sleep deprived. The symptoms can look the same. I’d want to try some aggressive pain meds, maybe a two week gabapentin trial even, and see if I could get laying down to rest.

Inability to hold canter (will she canter in the field?) tells me there is probably something going on up high behind - SI, hip, stifle.

Since you’ve tried treating the ulcers directly and haven’t fully resolved the symptoms - I’d probably table GI for now and go after pain. Not because it isn’t important - but because chronic pain can be the underlying cause of the ulcers.

This is a horse I’d love to start right off the bat in a bone scan - assuming that multiple areas will light up. Then you can follow up with x-ray or ultrasound in order of magnitude. That said, it’s a large upfront cost and it isn’t guaranteed to point you in the right direction.

[IPEsq]

It sounds like her nervous system is wound up. Maybe due to some kind of infection (Lyme or something else). Maybe pain related. Maybe neuro. Maybe all of the above? Canter issues can be weakness, neuro (from infection or not), or pain. Or all three. Hard to know with a horse that was recently a BSC of 2 what may be strength related.

She is probably sleep deprived unless you are seeing her fall in the cross ties or other places where she should be awake.

I think I would start by testing for infections because that treatment would be necessary regardless of other issues going on and just takes some blood tests to start. I’d test for anything with any kind of neuro component. Also test for Vitamin E and Se given prior nutrition problems. And basic CBC and chem panels.

If you find something that needs treatment there, give the treatment some time and then assess what has improved or not with the behaviors. Maybe do not try any canter for the time being.

[JB]

I would with a Lyme test, at least rule that out. It can easily cause all the issues you describe. Since that’s a blood draw I agree also with just testing selenium and Vit E. Those are really the only 2 nutrients you can test for, so don’t let anyone talk you into doing “nutritional analysis” of blood work (and for SURE don’t let anyone say you can do hair analysis for that, 100% cannot)

I would also test for PSSM1 - simple hair test through UC-Davie or Animal Genetics.

If all that’s negative then I would do a hair test through EquiSeq for PSSM2. No, I don’t agree with their testing as a method of determining if an asymptomatic horse has any variant, but I do think they have value in looking at a symptomatic horse.

[kaya842]

What a sweet faced girl, and kudos to you for taking her on.
What all has already been mentioned is spot on but I wanted to add that the way she shifts her weight/ rests her legs in the video looks like hoof pain to me (my now 18yr old grey TB mare, of all things, did/ does that when her hooves are bothering her). It can be difficult to see the hoof pain in motion if multiple hooves are sore, and she could have more than one thing going on. If you have a lameness specialist (or, even better, someone with a lameness locator device) nearby that could see her I would use them for the blood tests and have them do a lameness exam as well.

[Mistys_Girl]

Just a few things. She was a oft scale of 2 when I get her in September 2021, she did nothing but the odd walking short ride and some lunging until May 2022. July 2022 we put her on GastroGuard and she had time off again until September or October 2022. I got a new saddle in January 2023 that she likes better and moves better in. We haven’t gotten much past a walk trot ride with a few strides canter each way on a good day. She does hack around the fields at a walk with a bit of trot happily.
Blood work September 2021 was rough, blood cell issues and protein issues is all I remember. Blood was redone in February 2022 and was all in normal range.
I had front foot X-rays done when she got shoes to make sure all was good, April 2022 or so. Nothing showed up, no lameness, she was sound.
The sleep deprivation/narcolepsy she experiences has been happening the whole time I have had her. She does it inside and out. She’s out with 1 other mare that she has been with since November 2021.
Her weight has always been a struggle, she’s at best a 4.5 on the body scale, her ribs are just covered, finally.
The body shaking is what confuses me. She just started it in 2023 and it’s been increasing in occurrences. She’s not cold, or scared. I can go get her in the field and she’s shaking eating at the hay. Nothing we can connect to it and when it will happen.
Lyme is top on my list to ask the vet about tomorrow. EPM and cushings are on my list too. Another horse that was rough tested positive for cushings with none of the typical symptoms. On meds he looks way better.
It’s been a long, and rewarding 18 months with this mare, I just love her.

[JB]

@Mistys_Girl

The body shaking is what confuses me.

What are weather conditions when she’s shaking? How are you certain she’s not cold?
Does she seem to hurt, or be oblivious to the shaking?

Have you done a trial of gabepentin to see if it’s nerve related?

[StormyDay]

I’d definitely test for EPM. If you look at my post history you’ll see I have a OTTB who just mildly tested positive and he had a whole slew of issues from it.

Per my vet pretty much every horse over a certain age is mildly Cushings. She told me we could test for it but it probably wouldn’t be causing things like weight loss or neuro issues (in my horses case).

As for being cold, well, I have some horses who are total and complete wimps and will shiver in mild weather. My absolute wimpiest horse is my mustang who needs a medium weight blanket if it’s below about 55. So it can be very dependent on the horse.

What sort of situation is she in? Boarding barn? Is it busy? Is it possible she doesn’t feel safe to sleep? Some horses need a very quiet environment to lay down. It’s hard to tell from the video, but it does look like the stall is very open. This actually can make some horses really nervous.

You could also try a month of equioxx and see if it helps her. Then youd know if the issues are pain related. Sometimes rescue horses get into a cycle where they have muscle pain so they use themselves weirdly which causes more muscle pain.

[IPEsq]

From the video, that is not narcolepsy. But it does look like a sleep deprived horse who is not laying down for REM sleep. Her stay apparatus seems to be working ok. But if they fall asleep too deeply, it will fail in any horse. It is common for there to be a pain reason that they don’t lay down, but it could be something else.

Horse that is a neighbor to my horse in the barn had to be on stall rest a few months. She sleep crashed all the time. While she does have some chronic sores, I don’t see her do that when she’s getting turnout, even though she rarely sleeps in turnout. I don’t know what it was about the stall rest situation exactly, as she didn’t have a lameness too severe where she ought to have been able to sleep, and she did roll every day in the stall. But whatever it was, she was quite sleep deprived during that time.

[Pezanos]

I had a horse with recumbent sleep deprivation who collapsed like that. His cause was severe kissing spines. Maybe if something is impinging on the spinal cord it would cause the shaking? When we realized how much pain he was in we did give him a gentle passing.

[Mistys_Girl]

She’s at a quiet boarding barn, not many people come up at night. She’s out from about 8:30 until dusk, right now about 5:30, in the summer it’s as late as 9.

We did X-rays, her spine is clear, no kissing spines. That was my first guess with her.

I saw an improvement when we went to a grain free diet, which I have had success with in the past with other horses.

The shaking is definitely not cold. She’s bundled up and warm every time we have seen her shaking. Barn owner does blanket her one heavier than the rest with her being a wimp.

Will update after the vet comes tomorrow and again when we have some test results.

[Pezanos]

Good luck. UC Davis has an Equine Sleep and Sleep Disorders department that can serve as a resource. One feels so bad for them.

[jherold]

I’d test for epm and also treat with carafate for hindgut ulcers. Good luck

[kaya842]

Forgot to add earlier mine was shivering in 55 degree weather with a medium blanket on (no rain but overcast) and not clipped so I tested her for Cushings. Came back normal but low T4 which we treated with Thyro-L and the shaking/ shivering went away.

[Mistys_Girl]

Vet came and did shots and teeth and took blood. The shaking she confirmed was not because she’s cold, but muscle tremors.
Only blood we got back says she has an infection, which we found today. She has swollen teats and is very painful. On antibiotics, Banamine and GastroGuard for a few days. Have to monitor fever daily.
Vet is culturing what she was able to extract from her teats while we wait for more blood tests to come back.