Looking to tap into the COTH Hive Mind with a “zebra” medical issue.
Horse belongs to a student of mine, he’s an 8 year old 16’2" OTTB she bought last April. Had been OTT since the previous December; a war horse (raced for 4-5 years, 33 races), restarted by the seller/flipper after a brief letdown - they did several months of training doing basic flatwork - w/t/c and a little jumping. Passed a PPE with minimal “issues” - a little hock arthritis, a cold, set osselet in one fetlock, back felt fine on palpation (didn’t do back rads as a result), otherwise “unremarkable” results with no big red flags. Everything “looked good” for the work she wanted to do with him per the vet.
Started him in work at my student’s barn in the summer after a 30 day quarantine (her barn has a restrictive quarantine protocol where horses coming in are put into a separated pasture with a run-in - and not allowed to be ridden or worked in hand in any of the three rings on property), and so she started to ride him after that and rode him lightly, did some lessons with me along with a little groundwork to get focus. No issues other than greenness in the contact; we worked on getting a steady connection and a nice forward rhythm, did some easy lateral work and basic dressage, some cavaletti, etc. He didn’t go on Ulcerguard when he got there (in retrospect, she probably should have done this “prophylacticly” but he seemed fine, happy, non-reactive and relaxed while in quarantine - and wasn’t girthy, fussy or resistant.)
Anyway, fast forward to the fall - September - when he got a big gash/laceration on the inside of his hock. Vets started him on a round of Excede and Doxy, and when the swelling didn’t go down they gave him another shot of excede, extended the Doxy, and added 3 days of Gent. Overall he got 3 rounds of excede, 3 rounds of Gent, and was on Doxy for a month; she did give him probiotics during this time. He was on stall rest for awhile while this was going on, but it did resolve.
A short time following this he was put back into light work with another of my students as a part-lease; his owner was now pregnant so opted to stop riding at that point - but wanted to keep him in work. He was never lame during any of this, but suddenly started showing some resistances under saddle. There had been no changes to his diet, and the saddle fit was okay (if not perfect) per the fitter who checked it - and the massage therapist who worked on him said his back felt good; when I palpated it there was no reaction, and it felt soft and pliable. NO reactivity to touch at this point.
He began becoming girthy when tacked up, resistant under saddle (which came and went - mostly started balking at going forward and bending), and we figured it was physical so backed off work and immediately had the vet out, suspecting ulcers. He started to become cranky at being touched, especially in the girth area - so that was pretty much a “smoking gun.”
He was scoped, and they found multiple, small ulcers - so he was treated with gastroguard and sulcralfate for 6 full weeks - re-scoped at that point - ulcers were gone after a taper. The vet didn’t think he had hindgut issues so was resistant to trying misoprostal - but his owner wanted to rule it out so they did an ultrasound and the results were negative? (I suspected that he might indeed have hindgut issues because of his sensitivity to touch - especially in the flank area - but the vets said no. 
)
His hypersensitivity to touch kept increasing to the point where he started violently reacting to being touched pretty much anywhere - but especially near his hind end; gnashing his teeth, KICKING OUT and cow kicking with increasing “vigor” and purpose, and flinging his head up - and he also started becoming spooky (which was out of character), more reactive in general, and just SO unhappy that handling him became a bit dicey. He was clearly miserable. This was AFTER the full ulcer treatment, and after he scoped “clean.”
Vet came back out and did a Lyme titer test (which I had suggested earlier), he was negative! for Lyme. I have wondered about some other tick borne illness that might have become systemic - but there was never any fever - they did bloodwork but didn’t test for anything other than Lyme.
Stumped, the vets suggested that he undergo a full lameness work up at Morven. Since he wasn’t “lame”, I wondered about this but WTH at this point? Just delve deeper, right?
Anyway, they did a bunch of tests: Neuro, which came back very mildly positive - so they decided to put him on EPM meds “just in case” - and they did a workup with flexions, palpations, ROM exercises, x-rays, lameness evals on a circle, etc.
Here were the findings:
Neck: no pain on palpation of the poll or TMJ bilaterally. There was mild pain on palpation of the caudal cervical regions bilaterally.
Back: There was moderate pain on palpation of the dorsal spinous processes in the lumbar region. There was mild pain on palpation of the epaxial musculature in the thoracic region. There was marked restriction on dynamic palpation of the lumbar spine bilaterally. There was mild pain on palpation of the sacroiliac region.
LF: no significant findings on palpation of the distal limb. Normal range of motion and response to passive distal limb flexion. There was mild moderate effusion of the coffin joint. There was mild effusion of the fetlock joint. There was mild effusion of the digital sheath.
RF: Moderate pitting painful edema noted on the lateral aspect of the carpus and metacarpus. (He had injured himself in the field the night before, UGH, horses!!) Normal ROM and response to passive distal limb flexion. There was mild/moderate effusion of the coffin joint. There was mild effusion of the fetlock joint. There was mild effusion of the digital sheath. (This “resolved” in a reasonable time frame, FRT.)
LH: No significant findings on palpation of the distal limb. Normal ROM and response to passive hyperflexion of the upper limb. There was mild effusion of the fetlock joint. There was mild effusion of the digital sheath. There was a mild response to the Churchill test. There was mild effusion of the medial femorotibial joint.
RH: No significant findings on palpation of the distal limb. Normal ROM and response to passive hyperflexion of the upper limb. There was mild effusion of the fetlock joint. There was mild effusion of the digital sheath. There was a mild response to the Churchill test. There was mild effusion of the medial femorotibial joint.
Hoof testers: The patient was shod in open heel steel shoes with all four feet with pad on the back half of the foot on the front feet.
Lameness: The horse was trotted in a straight line and in a circle in each direction over a smooth and firm surface. There was a grade 2/5 RF lameness on a circle to the right. (Well he did “ding” himself before the exam, so…)
Utrasound of the dorsal articular processes of the back was performed. There was a mild-moderate remodeling of the dorsal articular processes of T15-18 and moderate remodeling from the dorsal articular processes of T18-L4 (worse on the left than the right.)
Radiographs of the back (DSPs only) were taken for review. There was grade 1 dorsal spinous impingement or “Kissing Spine” at T15-T17.
Neuro eval: Symmetry" symetric muscling throughout.
Cranial Nerve Evaluation: All cranial nerves appeared intact with normal response to examination.
Spinal Cord reflexes: Gelding was normoreflexive to the cerviofacial and local cervical tests bilaterally. Postural reflexes were within normal limits.
Gait Description (W/T): the gelding was noted to circumduct his right hind limb and drag the toe on a tight circle to the left. The gelding did not display any abnormalities when backed in a straight line. The gelding exhibited spasticity of his hind limbs when walked with his head raised in a straight line. The gelding crossed his forelimbs when walked downhill with his head raised.
Proprioception: Normal placement on tight circles in both directions.
Flexions: the following responses were elicited:
LF: DLF: mild
RF: DFL: moderate
LH: DLF: mild, ULF; mild, stifle: mild
RH: DLF: mild, ULF: mild-moderate+, stifle: mild-moderate
- Inflammation of the dorsal articular processes of the back
- Grade 1 assymetric sensory ataxia and hyper-reflexia - suspect EPM
- cellulitis of right forelimb (since resolved.)
They started him on Ponazuril, he has been on it for 3-4 weeks with no change. In fact, his reactivity has been as bad or worse!
Ugh.
The owner did start him on a magnesium supplement and he was a tiny? bit better - but it’s hard to say since there has been NO steady or noticeable improvement.
The vets want to treat the back issues by injecting with PRP and Osphos, and do shockwave. Student has tried to schedule this but the vet is out with (Ha! Oy!) bad morning sickness, so this will have to wait. Meanwhile, student is due to give birth in a month herself so has been trying NOT to handle this poor animal when he is “trying to kill her” and kicking out repeatedly when touched.
If you have read to the end, bless you!!, and thank you in advance! to anyone who has suggestions, thoughts or insights. My poor student is getting incredibly frustrated - and of course we all feel just awful for this poor horse. 
Appreciate all feedback!