Visit to clinic did not go well ...

[jmac84]

I am completely at a loss. The beautiful and sweet mare that I purchased in May started showing signs of front end lameness in August (truthfully I noticed intermittent NQR steps earlier but didn't want to believe that it was anything more than uneven grass footing or typical young horse one-sidedness - Yes, I did have her vetted but did not take x-rays as the vet who did the pre-purchase didn't think they were necessary.) A thorough exam by my local vet, with nerve blocks and x-rays up to the elbow, failed to identify the cause. We gave her time off and re-evaluated but she was still lame, although not quite as bad. So, I took her to the Fairfield Equine Clinic. The doc there found her to be lame on three limbs!! The left front (which is what I had been noticing), the right hind, and the right front - in that order of severity. The hind end was unfortunately easy to pin point. X-rays show moderate changes in the lower hock. (She is five years old and had only been worked and shown lightly as a four year old.) Nerve blocks of the left heel produced improvement, but then a block of the entire foot made it worse which the vet said is often indicitive of suspensory pain. Ultrasound of the left suspensory was mostly normal but vet did note a couple of areas that could be normal for this horse or evidence of "chronic avulsion". Basically, the diagnosis was bi-lateral foot pain, left suspensory pain and right hind arthritis. Her foot x-rays (including navicular) were all normal. Vet says the front end lameness could be secondary to the hind end and the suspensory soreness could be seconday to the feet!? I am not sure about that since my vet didn't even notice the hind end lameness. I am just overwhelmed by all this and seriously depressed. An MRI could tell us more about the foot pain, but I don't think I can afford it at this point, after all the money I have spent on vet bills already. I seriously question whether this mare, even if I can get her sound, will hold up to consistent work (I ride dressage and had hoped to hunter pace as well). My only thought at this point is to try corrective shoeing, give her the winter off, and bring her back in the spring after injecting her hock. I know I don't post often here, but I value the collective wisdom and experience of this board - Any thoughts or words of advice? Thank you! - Jen

[sublimequine]

To me, sounds like this mare might appreciate a no-riding life. Maybe you need a horse to just groom and play with and love on? I know she's young, and it's really unfortunate. But I've never met a horse who minded life without work. :winkgrin:

Did you get a PPE when you bought her, including lameness exam?

[Evalee Hunter]

No wisdom. No advice. Just OUCH! I am so sorry to hear all of this.

[Fharoah]

Sorry to hear about your mare. I know how the vet bills add up. My guy was diagnosed with a collateral ligament injury and a small tear in the deep digital flexor tendon with an MRI in May he is still on stall rest but has improved very slowly.

Best Wishes, hope your girl gets better!

[blackstallion]

The bi-lateral aspect is worrisome. DSLD?
Jingles for you and your mare :(

[Laurierace]

I understand why you would be disappointed but none of that sounds really major to me. I would talk to the vet about whether stall rest or pasture turnout would be best and then give her the winter off. There aren't many things that time can not heal if given a chance. Best of luck to you both.

[ljc]

I, too, am very sorry for what you're going through. I know how frustrating it is to have lameness coming from more than one leg. But I also believe that time is a great healer. Time, plus careful lay-up and rehab. I'm presently bringing my 7-year-old back from a torn DDFT in left front, torn impar ligament in right front. We're on month 14 and he's doing well. I gave him four months of stall rest with handwalking, then turned him out in the field here at home to let nature do her thing. I started trotting him about six weeks ago and so far, knock on wood, things are ok. I didn't like how he felt after a couple of weeks, so I gave him a few more weeks of walking, and now he feels wonderful.

I cannot over-emphasize how important good shoeing is, however. It's most helpful to find a shoer who's had experience with your horse's exact injuries. Lot of subtle stuff involved in corrective shoeing and this isn't the time to mess around with a less-than-experienced farrier.

I've brought many horses back from soft tissue injuries. I also kept my lovely A/O hunter going while he was dealing with arthritic changes (he's now nearly 21 and retired from showing, but one heck of a pleasure horse). In every instance, I took as much time as was necessary (in one instance, I gave that same A/O hunter a full two years off to recover from torn tendons. He came back sound as could be and showed for another eight years).

Bottom line - it CAN be done if you are patient and careful. Good luck!

[Altamont Sport Horses]

It is possible that she has injured only one foot/limb and the other problems are compensatory Did the vet suggest injecting the hock? I would consider treating the hock and giving her some time off to let the other problems heal. Then you could re-evaluate.

The hock arthritis could be from an injury. I know someone with a couple of horses having joint problelms who has injected the joint and then been able to maintain with a good quality joint supplement with HLA, specifically Acti-Flex 4000. http://www.coxvetlab.com/products/acti-flex4000.htm The horse with the most joint problems gets almost a double dose of this supplement on a daily basis and has not needed any additional joint injections. He needs more than the typical dose anyway because he is a daft cross weighing in at 1600 lbs.

[Pookah]

Honestly, I wouldn't panic over any of that. It is what it is, you can only go from here. It sounds like you went to a very very detailed vet who found every little thing wrong, which is good, but doesn't necessarily condemn your horse to a life of retirement. I had a very interesting conversation with my vet recently, where she told me about some limitations that they are finding in using xrays to diagnose arthritis. I don't know all of the details, so I won't go into more of the specifics, but her point was that if you xray a random sample of horses, some will have bad xrays but no hock pain. I am a huge believer in diagnostics, but I think that you need to find out as much as you can about what's going on, then step back and look at the whole horse, and treat that. A lot of what you mentioned could be shoeing related, and could be compensatory. I think your plan of fixing the shoeing, injecting the hock, and winter off is ideal, and on the plus side, at least this is a good time of the year for it.

My parents sent a horse to me last spring that they were going to retire because they couldn't keep him sound. I just decided to proceed as if he was sound, and he would either get better or get worse, and we could find and fix the root cause. Well, he's been dead sound ever since, he's even jumping little courses (he was just doing dressage), and trail riding, and hasn't taken a lame step. Can't claim any magic fix, and it could be related to a million different things, but the point is, horses can have problems and get past them. This particular horse had problems with his hocks, stifles, hooves, back, etc. . . but he's doing great and having a useful productive life, with none of those causing him issues. Don't panic yet after one visit, give her some time to heal, and fix what you can, and then see where you're at.

[findeight]

Get with the vet, the one at the clinic who did find something wrong, and see what they recommend.

It may be she needs stall rest and hand walking for a bit if she is foot sore. And does farrier have any opinion about the footsoreness? There may be something you can do to make her more comfortable, like pads or a bar shoe. Sometimes bruised soles can really make them sore and there is no way to grow them out when they are active on harder ground or turned out. Look into that.

Far as the NQR, just turn her out when you get the footsore thing worked out. Leave her there as a pasture puff. Look at her again in about 6 months.

I have known some pretty good show horses that have been off up to 2 years with NQR issues that defy diagnosis or "mild" suspensories that just don't seem to heal. After initial stall confinement, they went out and stayed there, big pasture in a group. Re evaluated every 6 months. About half of them returned to previous levels, the others were able to work at a reduced level.

This one is only 5. You got time. And I bet she had a few issues before you bought her and this is not new. Pretty common with the vague NQRs that they get them going well enough to sell them and do not give them the 6 months to 2 years off that will allow them to properly heal.

[grayarabpony]

First of all, make sure your horse's feet aren't adding stress to her legs. Improper trimming can ruin a horse's soundness.

Secondly, this horse probably will be able to come back with good management.

[jmac84]

Thanks everyone for your words of support - Its very much appreciated!! I have been trying not to be too pessimistic. She is young and has good basic conformation and I keep telling myself that time should heal whatever ails her. The fact that she didn't really improve after two months off threw me for a loop, however. Its very hard to deal with all this when I have only had her for six months. Plus, the whole diagnostic picture is so clouded. My vet really didn't think it was soft tissue, and she also did not see any hind end lameness. And although the clinic vet did detect some suspensory pain, it was not severe and the ulatrasound didn't really pick up much. But, could be lower down in the hoof where the ultrasound can't see. I know I should probably have the MRI done, but at the same time, given the expense and given that she is not severely lame, I kind of feel like whatever they find, the result may be the same as I would do anyway at his point - give her the winter off. The only question is - is it stall rest or just pasture? The clinic vet did say that the front end could be compensatory, i.e. she travels around on her forehand to take the load off her hock making her foot sore (she was barefoot when this all started, but I put shoes on six weeks ago - didn't seem to make a difference) and then the sore feet could alter her way of going making her suspensory sore? I don't know if it is worth injecting her hocks now, even if she is going to get the winter off?

Thanks again - I feel like I am desperately groping around in the dark

[3Spots]

Get the book "back to work," or at least read it at your local bookstore and you will see the rehab for most injuries is similar. And whether you had an MRI or not, the rehab would be similar.

My mare was given two months off and it didn't fix her, but I let her have turn out. She was not wild in turnout. An MRI diagnosed a collateral ligament tear and it was advised that I would need 9-12 months rehab. I did two months stall rest with handwalking and worked my way up there (2 months handwalk, 3 months mounted walk, 3 months trot, and then canter.) She is doing fine now.

So, in my experience, having the 2 months stall rest with handwalk was more effective than 2 months stall rest and turnout.

Hang in there.

[tma]

Similar symptoms with one of mine (no hind end problem diagnosed, however).

The MRI finally found the collateral ligament and deep flexor damage in one fore (although she had exhibited caudal heel pain in both fronts, and early on, the suspensory strain in one foreleg).

Relatively mild, fortunately - but definatly there, and more time off + adjustments in her shoeing + injections FINALLY made the difference. She is sound today (without the injections or compensatory shoeing).

But they aren't very forgiving - they take (a lot of) time to heal. In our case, it took over 2 years to get her completely back.

[ridenslide]

Ticture of time cures a LOT of things!;)

[grayarabpony]

I would turn her out -- although not in a big group with horses that she'll have to run with in order to keep up if one of them starts playing. Movement is essential for healing actually, if the movement is slow and steady. Can you turn her out with a quiet buddy 24/7?

[jmac84]

Its just her and her companion llama, but the llama can be surprisingly rambunctious at times, and she will run to keep up with him. She is a Haflinger so not naturally "hot". I do have a small sacrifice paddock that I could put the llama in or her for that matter. My husband complains when I "lock his llama up", but its probably the better course for now :)

[BornToRide]

The cloudy diagnosis tells me that the vet really has not found the true root cause yet.

Pull all shoes if she wears any, make sure she gets trimmed correctly and give her time off out to pasture.

What does this horse eat and could she possibly have any unrecognized frog infections that are causing the tenderness? Explore the frog with a hoof pick. If she flinches at any point, she has a frog infection. They can ber VERY painful to a horse!

[Dooner]

You mention "corrective shoeing." Have you seriously evaluated the quality of her shoe/trim? Posting pictures here or on one of the horse shoeing forums might provide some insight. Asking an inadequate shoer or trimmer to make changes for the sake of "correcting" anything is a recipe for disaster. Finding an excellent shoer/trimmer who can guarantee that she is balanced and level is vital.

Just my 2 cents, but bi-lateral suspensory soundness makes me suspicious of the foundation she is standing upon.

As for the hock injections, if they are causing her pain, then injections would definitely be warranted. You’re already going down the path of lameness related to compensatory changes in her way of going….Again, advice worth what you paid for it.

[jmac84]

Thanks again everybody! As for the feet - She came to me very over due for a trim with long toes and toe cracks in the middle of both front feet (worse on the right which is actually the "better" front limb) My farrier picked a bad time to go MIA, but I did find a guy who came highly recommended and had clients in the next town over. He finally actually did something about the toe cracks. Fungus had gotten in there despite my regular use of thrush buster, save-a-hoof etc.. He opened the cracks up to try to get past the fungus and get air in there. He did put shoes up front with side clips. (She had been barefoot) This was all after the lameness had already shown up. He did not think the toe cracks or her feet were related to her issues and neither did either of the vets. Local vet did comment that he did a good job with the shoeing. Clinic vet's shoeing recommendations are "Shoes to support foot pain are indicated. A wide web steel shoe that is fit full through the heels and is set back at the toe .."

[BornToRide]

He did not think the toe cracks or her feet were related to her issues and neither did either of the vets. They won't if they do not know how to read warning signs.

Persistent cracks like this are best treated with the right remedy, right from the start, like White Lightning or Clean Trax for example.

The poor hoof form could be a sign of bad trimming, but it can also be diet related. Hooves that are affected by too much sugar and starches in the diet, tend to be more susceptibel to cracking, excessive flaring, softness, thrush problems and general overall weakness. Perhaps this is really where the problem lies - that your horse is getting too many sugars and starches for what her hooves can tolerate, hence her soreness. Most vets and farriers still have to appreciate this connection .

[silver2]

I wouldn't stress too much over the hock x-rays unless she's actually sore or the vet was really concerned about it. My experience has been that 7 out of 10 horses you x-ray have "changes" and most of them are not lame. If you go looking for bony changes it's easy enough to find them.

I'd personally suspect her feet as the problem too, given the general "sore-ness" description. And if she's a fjord, possibly her weight. Get her feet solid and well trimmed/shod, keep her on good footing, put her on a diet if needs be and I wouldn't be surprised if she's sound pretty quick here.

[3Spots]

I wouldn't pull the shoes, either. If the injury is into the hoof, you want to keept the foot as stable as possible. I did an eggbar shoe with pads for the first two shoeing cycles.

jan

[findeight]

There you go...get the shoes they recommended.

Ya' know, sounds like this mare was a mess foot wise when you got her. Honestly, I'd just chuck her out in the fancy support shoes and leave her there for 6 months.

Never underestimate the amount of time NQR/vague suspensory issues take to heal...60 days is NOTHING.

Bet she is hurting but has also gotten body sore compensating and trying to protect whatever is hurting. Time will also grow a new foot and that ought to help.

[hollyhorse2000]

Was it fungus in the cracks or aneorobic bacterial infection? The latter is a different thing, which I have experience with. We used flagly both orally and actually pressed into the crack to cure. If you want additional growth, too, try Glanzen 3, which I use and have had good luck with cracked hooves. Finally, if you have a good equine massage therapist, I might suggest a good massage for your mare. If her feet hurt and it's affecting her movement, it may also leave her body sore, which can further complicate diagnosis.

Good luck!

[jmac84]

I too thought that the feet might be a factor, but as I said, neither the farrier or the vets thought they were related, but there has been fungus (anarobic white line type fungus I believe) in there for quite awhile and she did have minor toe bruising before I put the shoes on, which I would think could cause her to weight her heels, which could cause suspensory strain, etc., etc. I did pick up some white lightening and will try that. (She is not great about soaking her feet) Diet and weight are definately a factor - She is a Haflinger after all :) I put the grazing muzzle on her when she went on rest and has lost a little of the grass belly. (She was not morbidly obese or anything, but portly for sure) I had her on a ration balancer, but now with the soy issues I've been reading about here am going to try switching to a hay pellet, just enough for her supplements. Maybe Quiessence would help? This is definately helping me to talk through the issues. I am beginning to think it may be a case of a constellation of minor issues feeding off each other. I am going to try the white lightening treatment, follow the vet's shoeing instructions, continue to work on her weight, turn her out by herself but next to her buddy to minimize the antics and give the winter off. Hopefully, the spring will see her feeling better. She is great to ride and a surprisingly nice dressage horse (We were high score for the day at the only schooling show I made it to before all this got really noticeable and the judge loved her) I really hope I can get everything under control. Thanks again and keep the thoughts coming!

[BornToRide]

Diet and weight are definately a factor - She is a Haflinger after all :) I put the grazing muzzle on her when she went on rest and has lost a little of the grass belly. (She was not morbidly obese or anything, but portly for sure) I had her on a ration balancer, but now with the soy issues I've been reading about here am going to try switching to a hay pellet, just enough for her supplements
There's you problem right there. I bet this mare is actually subclinically laminitic and that's why she's not quite right in her hooves/legs. The toe bruising is to me another clue.
I have a client with a Haflinger mare - that mare is also VERY sensitive to her diet, but does beautifully barefoot with the right care. When the mare got her teeth done recently the first thing the vet commented on were her beautiful bare hooves. :)

Clean up her diet, trim and give her plenty of exercise and you will probably have a sound horse - even bare.

Best wishes!

[Bosspaige]

I am in CT and my mare who is 11 has been what I would call uneven starting back in May. I would watch her go and think sometimes it was her left hind, sometimes her right hind and sometime it looked like she was sore up front. On other days, she would lunge like a lunatic and be fine. I had the chiropractor look at her and he said she was really locked up in her right hip. She did mildly improve after he worked on her but not great. I decided to just give her a month off to see if it helped. At the end of 5 weeks, she was still the same. I had the vet out and he also so shifting lameness. He x-rayed her front feet which showed very minimal navicular changes (which he said was so slight, he wouldn't recommend any changes in shoeing), and her hocks showed the beginnings of arthritis. He also drew a lyme titer and both the standard and western blot came back positive....I treated her for 28 days with 45 doxy 2x/day and she is back to her old self. I kept saying she felt like she was missing a gear and we have found it again! Might be worth a lyme titer before going to crazy with all the other stuff. It sounds like the vets weren't 100% sure of anything with her so it might be worth a shot.

[Tamsin]

I agree with those who say that time is a great healer. A winter off may make all of the difference. Jingles and good luck!

[ddashaq]

I went through something similar with my horse, so I understand the frustration and worry. Mine is a long and boring story that I am not going to bore you with other than to say that I would HIGHLY recommend getting either a farrier or trimmer with experience dealing with lameness involved. I would have skipped 6-9 months (it is hard to pinpoint exactly how many months set back we had!) of lameness had I had a competent hoof care professional taking care of my guy. The good news is that now (12 months later and with the help of two outstanding farriers) my horse is sound. Best of luck to you and your mare!

[Watermark Farm]

If she were mine and I had such a hazy diagnosis, I'd probably pull all her shoes and give her a restful pasture life for at least 6-8 months. Then see how she does. Make sure she's getting good balanced hoof trims. Her troubles do sound partly compensatory. Make sure you have her teeth evaluated. Dental issues can affect soundness!

As my farrier says: "Pull shoes, turn out and ignore twice daily."

[onelanerode]

I was in your shoes four months ago.

Definitely take a good look at the feet ... a critical look. If you aren't sure what a good balanced trim looks like, learn. And then compare that with your mare's feet. You might be surprised. I certainly was.

I strongly believe that healthy balanced feet are essential to a healthy horse. If there is something wrong with the trim, it will almost certainly manifest itself in other areas of the body.

Look at the diet as well. What works for one horse may not work for another, regardless of what your BO says or what the feed rep says.

Chiro/bodywork can do wonders. Find someone good and watch how your horse responds.

Feel free to PM if you need a sympathetic ear. I know how hard it can be to try and figure out the "right" thing to do. :sigh:

[lalahartma1]

Yup, my mare had a mystery lameness, xrays, no visible signs of injury area afflicted pasturn/fetlock. After @ 5 months she's good as new, but we have to get back in shape. Two months hardly put a dent in it!

Sorry to hear about your mare! And good luck!

[luv2jump]

When he blocked the right front heel did she go off on the left front?? Did he then block the left front foot to conclude bilateral heel pain?
After blocking the right foot and having her go worse, did he block up higher to try and find the source of pain (like block the origin of suspensory after getting questionable images??)
Did he block the hock to confirm the source of the pain, or base it on radiograph only.

[jmac84]

I don't have the vet's write up in front of me, but I will try to summarize as best I can - The LF was the most obvious so he started by blocking the LF heel which did result in improvement. He then blocked the RF heel and she was almost completely sound. He then blocked the entire LF foot and it actually got worse. He then did a couple more blocks working up the LF leg. I can't remember exactly which block then got her sound again but it was just below the knee. The write up states that the LF suspensory "looked good" on ultrasound, with two small areas of possible irregularities that could be normal for this horse. Palpitation of the LF supsensory produced a mild to moderate response basically right in the middle of the supsensory along the back of the cannon bone. (Sorry, I know I am probably not using the most technical terms!)

[jmac84]

Also, after he blocked both heels and she looked sound, he was discussing the possability of injecting both coffin joints, but then when he blocked the whole LF foot and she looked off again, that combined with the response to palpitation made him think that the suspensory was at least a component of the problem. He did not block the hock, but he and his assistant both thought she looked consistently short in her right hind. Again, this is not something my vet or trainer ever noticed. But, the x-rays did show moderate changes in the lower RH. YIKES! Could this get any more confusing!!

[bt]

Maresy needs some new shoes, been in your situation before, stayed there for over a year until I found a farrier who "got the gut" ie he had the instinct/skill/intuition to do what my horse really needed (pretty basic good trim and properly fitting shoes), which was not what the vets recommended(yes I did try the aluminum web w. high heels, just got me and my horse more broke). Find a blacksmith you trust, try and be patient while the healing process runs it's course, drink heavily if needed. JINGLES.

[BornToRide]

How fool proof are nerve blocks anyway? I mean could something have gone wrong during the blocking and sent the wrong message?

[findeight]

You got several things going on here.

Not going to tell you what to do or not do but I would not inject anything unless I had a clear diagnosis to justify it. The injections are expensive (average 100 to 200 per site) even when you know what they are for. Why stick them in hopes it is going to fix whatever is wrong when you don't know what is wrong? Plus it is invasive and there is always a slight risk of infection.

With the added info you have given, I am going to weigh in with bad feet complicated by a suspensory and weight.

Usually, suspensories are best on complete rest for a period with handwalking only. Once they get more comfortable and the thing has had a chance to start healing, they can go out IF they stay quiet.

If she was mine, I'd get the fancy support shoes. Stall rest and hand walk for 3-4 weeks then put her out for 6 months.

Some of them you can pull shoes on with no consequences but, if she is already bruised and sore, I wouldn't for now.

Look into nutrition and hoof supplements to get you a good, healthy foot during the off time.

If, in 6 months, she has a better hoof but is still NQR, get the additional tests done.

Have to also say...if she has white line issues, splits/cracks and the vets recommended support shoes, cannot understand why farrier is saying feet are not implicated in her overall condition.