NQR - Update Post 18

[avezan]

This is very frustrating. My horse is very slightly off. I have been trying to bring her back into condition from a 1.5 year hiatus where I rode her intermittantly during that time. I have saddle fit issues, but recently have found some that seem to work. Now we have a very slight "off-ness" that is hard to pinpoint. She was VERY stiff to the left when I first started riding her. This has gotten better. Now she is short strided and not very interested in moving forward. I put her in a round pen naked to see if I could see what I was feeling under saddle, and I did see it. So, it is not my imagination. I did give her some bute the other night and rode her the next morning and everything felt fine. I gave her bute yesterday morning and rode this morning and the NQR is there. So if the bute did help the other day, it was after 12 hours, but the effect didn't last 24 hours. If it even worked at all.... this is so slight, it is hard to tell.

When she is focusing on something, that NQR is not there. If I ride her in a field, or really ask her to concentrate on something...she is fine. It is only when she is poking along, and I'm not asking for anything, does this show up. It is a slight unsteadyness at the trot. not a regular head-bobbing lameness. If I take her to a clinic, I'm sure she will not show this. I don't really have any vets that would come to my farm that I would trust to make a diagnosis given the very slight symptoms. But I'm willing to try taking her to a clinic.

So, here are my questions. I had thought about having a chiro work on her after I saw the initial stiffness when I first started working her. Do you think I should try this first before taking her to a clinic? I did put her on an HA supplement. I'm thinking of giving her adequan or something similar as well. I dont' think this is an acute injury. I think it is probably the start of something, or the result of something from a long time ago that is starting to cause issues. The horse is 13. A good time for some arthritis to kick in! The work I have been doing so far is just 20-40 min of W/T/C. No jumping. I have been doing this inconsistently for the past month, but consistently (5 days a week) for the past 2 weeks. The NQR has been more consistently apparent in the last week, and this morning I stopped after about 10 minutes because it was definitely there (although still subtle! aaargh) This is not going away, so I need to do something.

My reservations about taking her to a vet are that I don't think most vets are going to see this. I dont' want to spend thousands upon thousands to x-ray, ultrasound, bone scan, MRI, etc every joint. Hence my thought about a chiro first (who is a DVM). I would love suggestions of vets who are REALLY good at diagnosing something from the ground. ie someone who would not first jump to technology, but get a good idea of where the problem might be before doing the x-rays. I have one suggestion that I will probably follow up on. I have used him before and his prices are very reasonable.

Thanks for any suggestions. All will be thoughtfully considered.

[mvp]

There are probably 1.5 million horses floating around in your horse's predicament. Mine middle-aged gelding was one, and my vets told me two things that helped:

1) Arthritic horses look like "train wrecks" when they come back after time off. Make them comfortable and keep going.

2) Many problems go away when the horse is fit. And that takes longer than we think. For my gelding, that meant 4 months before I could come out without asking the "Is he NQR today? This step?" etc. A year later, my vets said "Don't inject nuthin'. He rocks."

3) Horses can be and need to be much fitter than we non-event riders, non-Olympians thing.

I'll add my own caveats here:

4) Horses who have had time off need to get mentally prepared to get back in work. Just as we find it tougher to go to the gym month one than we will month six, the same is true for horses. Do things with your mare that keep her mind occupied while she works through the initial PITA of going back to work.

5) If you want to really get a good evaluation from your vet, you need to ride her hard enough to either make her better or appreciably worse. I have just one horse whom I love and whom I can't afford to cripple, so I'm the last person on Earth who wants to try this kind of experiment. But skilled horsemen do and know how to use it.

Hope this helps. Go outside and ride her, pony her, lunge her in side reins, long line her. Mix it up, start with plenty of walking and trotting to build up her ligaments and then try to not ask how sound or not she is for 60 days or so. Use bute and cold hosing as you need to.

[cb06]

I had this exact same problem...on again, off again NQR. Because diagnosing this type of lameness can be a bit of an art form that really require experience, what made the most sense to me was to go straight to an expert. You would have to trailer there, but I would recommend a trip to Virginia Equine Imaging (Dr. Kent Allen), in Middleburg, VA. They specialize in diagnosing lameness issues and I consider it time and money well spent.

[avezan]

Thanks guys. MVP, you think along the same lines as me. My ususal protocol for NQR is to keep riding and one of 3 things can happen: 1. The horse gets better (great!) 2. The horse gets worse (vet can diagnose better) 3. The horse stays the same (crap!).

So far, my horse has either stayed the same or gotten a little worse. It could be that I am just more attuned to it now, and not that it is worse. it sounds from what you are saying that I need to give it more time. She does seem to "work out of it" if I work her. If I really ask her to work (ie go on the bit, do some lateral work, something that takes concentration on her part), the NQR is gone and by the end of the ride there is no sign of it. This is a very special horse, my namesake, and the thought of pushing her when she might be hurting is very hard. But she and I communicate very well. I am not getting this feeling from her (that I am pushing her and it hurts). Just the NQR that I can feel physically and have seen. Fitness is definitely an issue, and I agree that if she is more fit, this might go away. Same with saddle fit issues. The fitter she is, the better the saddles fit. But this is quite a catch-22!!

So, one of my questions is should I ride her in such a way that I don't see the NQR? In other words, should I put her to work? Should I ride out in the fields more to get her fitter? I will give her some bute in the evening and ride her in the morning since that seemed to help. I'll talk to my local vets and see if they have suggestions. If it does get worse, I'll talk to Dr. Allen. I have spoken with him before (by e-mail I think!) about another horse, and he does have a very good reputation. But he is the type that I worry about ending up spending lots and lots of money on diagnostics.... If I get to that point, I will go there. But I don't think I'm there yet. :)

Any thoughts on chiro? I've only ever done it once on another horse years and years ago.

cb06, did your NQR resolve? I hope it had a happy ending!

Thanks for the suggestions! You have made me less depressed today.

[Fharoah]

Been there done that with my good day bad day not quite right gelding. Bute will only lesson soft tissue injury so if it is tendon ligament bute may not resolve the lameness.

First lounge or ride your mare and get a video showing her off. During my geldings exam in June with top notch lameness specialist/sergeon, my horse was a little short for five steps then sound the rest of the exam. He showed no lameness on the lounge in either directions, he flexed out negative, he had no palpatable abnormalties. He said he takes a few shorter steps but he is basically sound. I said he does not feel sound, handed him a video, he had a history of ligament damage in his pastern new x rays showed articular ringbone.

I would not rule out soft tissue injury based on only NQR.

In my experience intermittent NQR usually turns out to be more serious e.g. collateral ligament. The sooner you get the correct treatment the better the outcome usually is.

[lstevenson]

You're in VA, so I would take the horse to Dr. Allen or Dr. Johns at Virginia Equine Imaging. They are able to see even the most minor lamenesses (where many think the horse looks just fine unless it is outright limping), and will get to the bottom of it.

If it's a new problem, I would not go the route of ignoring it to see if it goes away. I would want to know what it is. Good luck!

[avezan]

So I gave the mare a week off with some bute the first 4 days. Then my farrier was out the morning I was going to try riding her again. I decided to put her in the round pen and asked my farrier to watch her with me. Well, to my surprise and chagrin, she was quite lame to the left! So much for NQR, this was SDNR, something definitely not right. I called and made an appointment with Dr. Allen. The appointment was today. My farrier wanted to come with me! What a great guy. Good news and bad news. She was a 3 lame to the left still, and maybe a 1 to the right, which is what I had originally seen. Only on a cirle on hard footing. In soft footing and straight, I really couldn't see anything. Flexions and x-rays did not show anything. That's the good news...and the bad news. We still don't know exactly what is the problem. She did block out in the coffin joint to about a 1.5 to the left and barely noticeable to the right. So he injected her coffin joints, both feet, recommended "onion" shoes, and shoeing the hinds (she was barefoot behind) and starting her gradually back to work and see what happens. Cross your fingers that this does the trick. My farrier stayed and put the shoes on tonight. (have I mentioned what a great guy my farrier is?) Thanks for the recommendations. We will go back in 1 month for a re-check. If the lameness is still there, we will consider other diagnostics like a bone scan. I don't think I can afford the MRI.

[Mara]

Fingers crossed for you!
But what are "onion shoes"?

[horsepoor]

Hopefully things improve, but in case you do have to go back I wanted to mention my thoughts on bone scan vs. MRI. Having done both bone scan and MRI in order to diagnose a recent collateral ligament injury, I'm not sure they are that much different in cost? Esp if it is a standing MRI (the gen'l anesthesia for the lay-down type really adds to the cost). For mine, the bone scan was $1,500 (we did full body as there were some things going on in the hind end that we wanted to check out as long as we were looking at him). The MRI of both front legs was also $1,500 but then another $300 for anesthesia. I would say that if you have a pretty good idea where the problem is, which it sounds like you might, I'd go straight to MRI and skip the bone scan. Esp if it is a standing MRI...for me, I went bone scan first as I really worried about the gen'l and this particular horse, and a standing MRI wasn't an option in our area, but all that lit up was the same old suspect (front feet), so we had to do MRI to get a clear picture of the ligament injury.

But of course, hindsight is always 20/20!

Now I have to ask - -what are onion shoes?! I haven't heard of those before.

[horsepoor]

But what are "onion shoes"?

Oh good - I'm not the only one that doesn't know!

[Pancakes]

Keep in mind a bone scan will only tell you WHERE to find the problem, not WHAT the problem is or how it must be fixed. To truly make the bone scan worthwhile, you should add to that cost ultrasound +/- radiographs to fully diagnose the cause of the lameness.

If you have a good vet who is reasonably certain the lameness locates to below the fetlock, then MRI is a good option for both location and diagnosis.

Weigh the costs/benefits of each...

[avezan]

I had never heard of them either. My farrier seems to have heard of it, but Dr. Allen showed us one. It has wide heels that are a little hollowed out, then wider at the toe, but set back. It is instead of a bar shoe.

As for MRI vs. bone scan vs. both. I'm really hoping we don't have to go there. He quoted me $700 for a knee down bone scan of both front legs and $2K for the MRI. If/when we get there, I'll talk more about options and outcomes and prognosis.

[Watermark Farm]

You have a lot of directions to go in, but I'm suggesting one cheap and easy thing to look at. I've had a lot of luck using a book called "Beating muscle injuries for horses" by Jack Meagher. I recommend this book so much I feel like a broken record. It's super easy to use and makes you think about NQR-ness in a whole different way.

My gelding underwent bilateral neurectomy after 2 years of terrible lameness from sidebone. He was only 95% sound after the surgery (same as when he was blocked, so no surprise). I was prepared to accept this and made him a pasture pet. I realized at some point that his left shoulder hurt, so I pulled out Meagher's book and bumbled my way through some muscle massage. Voila, and my horse went 100% sound right then and there. I deduced that 2 years of lameness had caused him some muscle injury from moving in a shuffling way. I work on him whenever he's NQR, but overall he has stayed sound.

Just another piece of input. I am big on taking the horse to a very good clinician and having them see what you are seeing, under saddle, etc etc. I have one vet I like to use who will actually sit on my horse and *feel* what I am feeling, which is very helpful at times.

Check out that book, it's $15 and is such an important part of my NQR repetoire! Also work with a good chiropractor, that's another piece to look at when considering NQR.

[WW_Queen]

I spent thousands upon thousands in dealing with an NQR over a few years, when a few hundred could have properly diagnosed it.

Get a real lameness vet and spend the money now, versus wasting years of lost competition time and money on "try this! try this!" like I did.

*sigh*

[Gry2Yng]

There are probably 1.5 million horses floating around in your horse's predicament. Mine middle-aged gelding was one, and my vets told me two things that helped:

1) Arthritic horses look like "train wrecks" when they come back after time off. Make them comfortable and keep going.

2) Many problems go away when the horse is fit. And that takes longer than we think. For my gelding, that meant 4 months before I could come out without asking the "Is he NQR today? This step?" etc. A year later, my vets said "Don't inject nuthin'. He rocks."

3) Horses can be and need to be much fitter than we non-event riders, non-Olympians thing.

I'll add my own caveats here:

4) Horses who have had time off need to get mentally prepared to get back in work. Just as we find it tougher to go to the gym month one than we will month six, the same is true for horses. Do things with your mare that keep her mind occupied while she works through the initial PITA of going back to work.

5) If you want to really get a good evaluation from your vet, you need to ride her hard enough to either make her better or appreciably worse. I have just one horse whom I love and whom I can't afford to cripple, so I'm the last person on Earth who wants to try this kind of experiment. But skilled horsemen do and know how to use it.

Hope this helps. Go outside and ride her, pony her, lunge her in side reins, long line her. Mix it up, start with plenty of walking and trotting to build up her ligaments and then try to not ask how sound or not she is for 60 days or so. Use bute and cold hosing as you need to.


I did a search to come up with this thread, but I just wanted to say mvp that this post really hit the spot. Thanks.

ETA: I have Meagher's book. Going upstairs to look at it now. I have a shoulder issue, probably caused by saddle fit. Trying to get it right. Saddle is off to be re-flocked right now.

[mvp]

Glad my old posts helped. Here's more

On soft tissue--

My vets also taught me to palpate my horse's suspensories. You can flexors too, if you like. They made two points:

1) Horses coming back into work, increasing their work load as when they start jumping, or working hard over a range of different footings put new stress on their tendons and ligaments. You really want to keep track of suspensory health.

2) Suspensories hurt before they actually tear. They can produce all kinds of NQR, though there are clear lameness tests that will help you deduce a problem. Trotting on a small circle will sometimes reveal problems, and trotting on the same circle in deep versus shallow/hard footing will tell you things too. The suspensories help stabilize the leg in deep footing, so you ought to see more pain and wonky unevenness there.

But the real punch line is that you can learn to judge the state of your horse's suspensories by palpating them.

Holding the leg bent, palpate down from the knee or just behind the hock (I mean get way up close to the joint) and pinch the loose ligaments as you work down the leg to the widest point of the feltlock.

You will be able to feel the various branches. In the bent hind limb, you need to move the flexors over and stick your thumb underneath those to palpate the high part (close to the origin) of the suspensories that are deep to the flexors here.

If you are really good, you will be able to appreciate the texture of the tissue and do crazy fancy stuff like feel ligament versus it's surrounding sheath. I can't feel this.

But you will definitely feel your horse's response to pain, and this is important: All horses have a "baseline" level of reactivity to this kind of palpation. You must learn your horse's own and then use palpation in a comparative way. Also important: Slightly more pain with more work isn't an "official" problem, but something to keep an eye on. It should decrease as these ligaments rebuild themselves in response to increased loads.

So palpating suspensories isn't equal to ultrasound for diagnosing suspensory injuries. It is a good "down home" kind of tool to use with others to see if you might have a reason to haul drag out a DVM and his machines. It's also a fantastic way to prevent injuries.

Poke around your horse's tender legs in good health!

[avezan]

I guess I should update this. I didnt' update after the re-check 1 month later. Unfortunately, it wasn't good. I did ride her in the onion shoes, gradually working up to some trot and a little canter. I thought it was good at first, but then I noticed the NQR again. When in a round pen, it was much more pronounced. It was also more obvious on hard surface than soft. Her feet are as hard as rocks, and do not test, so this didn't make a lot of sense. We blocked the left foot completely, and she went 100% sound on the left (some things showed up on the right, but nothing too concerning at that point. There's always something, right? ;). Dr. Allen ultrasounded her foot and found abnormalities in her lateral collateral ligament. He didn't see a lesion, but it looked a little larger than on the other side. Then he did find a lesion on her DDFT where it joins P3 (? the bottom of her foot). He thinks she probably really torqued it at some point playing in the pasture. He prescribed shockwave therapy, bar shoes and 3-6 months rest. We have had one shockwave treatment and I am trying to find the time to get her back there for another. I did put her in the roundpen after about 1 month of rest to evaluate her, and I thought it looked better, but every once in a while I saw a funny step. In hind sight, I think those funny steps were when she was off the track of the round pen. I have deeper sand on the track and harder footing in the middle.

So, that's where we are. She will have the winter off and then we'll see where we are in the spring. For what its worth, I'm giving her SmartPak's SmartTendon. Its cheap and if it works, great, and if not,...its cheap. ;)

[avezan]

I thought I would update this. It has been almost a year since my last post on this thread. I did post another thread this spring.

So, a winter off did nothing. In the spring she was still NQR but definitely off to the left. She was sound on a straightaway and on soft ground. Dr. Allen said if I just rode her in a straight line, she would be fine. ;) He convinced me to do an MRI. In hindsight, a very good choice!

MRI showed navicular bursitis in the left foot and MRI confirmed what the ultrasound had shown, that she had a compensatory suspensory strain in the right front. Dr. Allen and Dr. Hyman did x-ray guided injection of the navicular bursa and ultrasound guided PRP in the suspensory. A few shockwave treatments and 4 months later ..... and the horse is SOUND! woohoo! We just got back from our last check up. No lameness either direction on the circle on hard ground. Ultrasound of the suspensory looks good. Avezan is cleared for turnout and to start back slowly to work.

I am so happy! I just thought I would share my happy ending with you. Thanks for all the suggestions. LOVE Dr. Allen and VEI!

[CHT]

So glad it worked out for you and your horse!

[Roxx]

Great news azevan! Good luck with getting her back to turnout safely :)

[princessfluffybritches]

I have been reading her about alot of tests, but did anyone xray the horse's feet?