[Auventera Two]

I'd like some input on a horse I've been trimming for about a year, if anyone can help. The owner gave me permission to post this, but I told her I'd omit names and such. So lets call the owner Suzie.

Suzie has owned the horse 5 years. During that time, he's had one hind-end lameness after the next. Vet exams and radiographs consistently fail to show anything. The vet kept coming back to "soft tissue injury" because there was really nothing else to diagnose it as. Rest the horse, put him on a good joint supplement, and go back to work when he's sound again. Then boom - another lameness of some sort. Rinse,,,,,repeat.

Suzie spares no money on this horse. She's had various vets examine him. She's had radiographs up the wazoo. Vets tell her she's crazy - the lameness isn't that bad. Inject his hocks if you want to, give him a little bute, and quit worrying so much.

The horse had a succession of bad trims from about 5 different farriers. He'd go totally lame for weeks at a time, and need bute for pain relief. I started doing the horse and the trim protocol was to leave more hoof - plenty of wall height above the soles so the horse had some ground clearance. Owner tried shoes in the past but even wearing bell boots 24/7, he would manage to step shoes off left and right. He doesn't interfere when barefoot.

Horse has been sound and back in work for at least the last 9 months or so. Gone to a couple of shows and cleaned house - really really making improvement.

Owner was curious about sole depth, health of coffin bones and navicular bones, etc. so had a huge set of radiographs done a couple months ago. I mean, she spared no expense. Lots and lots of films. Everything came back perfect. Nothing at all, except possibly a small arthritic change in the right hock, but nothing that should cause any problems, or lameness at all. Hoof balance was good, joint spacing good, about 15 mm of solar depth, nothing to even remotely raise an eyebrow over.

Also in the summer the horse had a full blood panel done, also thyroid and insulin/glucose levels just for grins. (Owner is really dedicated to good health). All came back perfect.

Over the last year, horse has developed diarehea that won't resolve. It's not terrible, but watery poop, dirty butt all the time. At various times vet has attributed it to stress from trailering, too much green grass, just dewormed, etc. But owner isn't satisfied with this answer.

One month ago I was out to trim and noticed filling around the lateral branches of the suspensories on the left hind. Owner hadn't really noticed it, but did see it after I pointed it out. She said horse is sound, doing great, no problems. She walked, trotted, and turned him both directions before and after the trim - as we always do. Suzie and I both thought horse looked great.

The same day I was out, horse had a cranio-sacral treatment. Not entirely sure what that is????

Next day - horse goes lame. He was visibly off on the left hind. That made sense, because that's where the filling was. Owner did not call me or vet because she thought horse just tweaked himself, or got into a pasture scuffle and a few days of rest he'd be fine. And he was. Then he went "off" in that leg again. This went on back and forth over the month. She has called the vet out so many times over the years and every time they tell her - sorry, we don't know what to tell you - rest, bute, gentle exercise when he's better - that she didn't call the vet out this time.

Finally 2 days ago, Suzie called vet, vet did lameness exam and he flexed "off" in the left hind stifle. She did 3 radiographs. Results from that are not back yet, but radiographs in the past have shown nothing. Suzie asked vet to inspect feet. Vet said feet look great, balanced, wouldn't recommend any changes.

I went out yesterday to trim, and horse is a bit off in the left hind. Both hocks also look puffy, almost capped. But here's where it gets weird.....

He's lost a fair amount of weight in the last month. Pasture has not changed. Amount of hay eaten has not changed. Hay/grain/supplements have not changed. This is a small, VERY well run boarding barn. I know the owners, I know who feeds, and they are absolutely meticulous. It's a really great place. Owner checked with barn - nope, no changes have been made.

Horse has lived there for 5 years. Never lost weight unexplicably before.

The horse's coat looked dry and unhealthy to me. Like sunburned and rough. I hadn't really noticed that before.

With the weight loss, he appears to have a prominent "hunter's bump" that wasn't there before. Vet (also a chiro) said there didn't appear to be anything wrong in that area - nothing was "out" and he wasn't sore at all.

Owner doesn't think horse acts 100% like himself.

So....I was reading that other thread about verminous arteritis and thought....hmmm...

Called owner, asked about deworming schedule.

Birth to Age 3 - no data
Age 3 to Age 5 1/2 - dewormed every 2 months with Ivermectin. NO ROTATION. He came from a crappy place, bad husbandry, etc.

5 1/2 to present (about 5 years)

Jan - Strongid
March - Equell
May - Safeguard
July - Strongid
Sept - Zimectrin Gold
Nove - Safeguard

So, it is possible, even the teeniest itty bittiest bit possible that this horse may have some funky worm thing going on?

Horse is pastured 24/7 with a shelter, and one other horse that he gets along fine with. He gets 4 oz. day of Equishine, 3 flakes of a grassy/alfalfa mix hay a.m. and p.m. and about 1/2 lb. of the barn's general sweet feed, just to make him feel he got something. This has been his feeding regime forever.

Teeth are done every 6 months by a dentist. Sheath cleaned every 6 months under sedation.

Seriously, you've never met a horse owner so dedicated to her animal as this lady. Absolutely nothing gets skimped on.

[shawneeAcres]

With the strangely intermittent lameness and now loss of weight and condition I would be looking at possible neuro causes, specifically EPM

[Auventera Two]

Yep, I should have added - vet did a neurological exam (not sure what it consisted of???) and said he was fine. But that does keep popping up in my mind as well. Maybe a 2nd opinion is in order.

She has talked to another vet at a major equine clinic, and once the radiographs are developed from the stifle, they want to see the horse.

[Calico]

Sounds like it's time for scintigraphy and a lameness expert.

[Rick Burten]

Has a fecal exam been done recently or ever?

Idiopathic lameness is one symptom of EPM, but considering there is DJD in the hock, I would look to that first.

The weight loss could also be related to/due to stomach ulcers so it might be worthwhile for the horse to be treated for ulcers. And, it is not unheard of for ulcers to cause enough discomfort that the horse changes its gaits sufficient to appear lame.

[deltawave]

Lameness/claudication from vascular insufficiency ought to be (of course nothing is perfect, and horses aren't very good historians) very clearly a "threshold" thing--the discomfort only shows up at a certain level of exertion, is relieved by rest, and crops up again at nearly the same level of exertion. It's much less likely to be an "off and on" type of thing, or something that gets better with exertion, and should virtually never be present with minimal exertion unless it has gotten to a critical stage, in which case I'd expect to see cold limbs, diminished pulses in the legs, etc.

Should not be too difficult to palpate the horse's femoral/pedal pulses before and after exercise in the affected limbs. Could also check pulses in the tail before and after exercise--the same vessels supply the whole back half.

Odd bumps notwithstanding, it is simply not physiologically possible to see or palpate the aorta through a horse's spine! I'm not sure of the exact level at which it bifurcates, but by the time you get to the lumbosacral area, I'm pretty sure the aorta has long since turned into the iliofemoral system anyway.

[Rick Burten]

Lameness/claudication from vascular insufficiency....

is claudication seen very often in horses? As regards the limb, where would it be most likely to occur? Is it not also a possibility that the lameness could be related to a neurological claudication caused by a stenois of the spinal canal and/or compression of the root of the nerve?

[JB]

Just food for thought:

It's been documented that neck threadworms can set up housing in ligaments (not sure about tendons) and cause lameness issues that way.

[egontoast]

radiographs' up the wazoo ' are of no help in diagnosing soft tissue injuries. Have ultrasounds been done of the filled leg or anything else?

I don't see anything in the list of investigations done which would rule out issues with ligaments, tendons, soft tissue injuries. Ligament injuries, for example, can be very subtle and chronic.

[Auventera Two]

Good posts guys, keep 'em coming!

Rick - Fecal exam - yes to a recent exam. The vet took one when she was out a couple of days ago. We don't know the results on that yet.

Delta - exertion - the lameness becomes apparent with significant exertion, then a week or so of rest is significantly better. The day before the trim and cranio/sacral treatment, the horse did a moderate workout in the cart with two people on board. But in the past, the hard works may or may not have created lameness, just depends.

With normal, every day work, the horse is generally okay. It's when he has a particular hard schooling that he goes "off." But yes, at times, the lameness has been there even without a significant workout.

I have so much detail on this horse, I've omitted a whole bunch in the original post. And it came out to be a short novel as it was. I'll try to answer what's missing as you guys have questions.

Good idea Delta on checking pulses. We've of course checked digital pulses, both myself, and the vet, before and after work, and there is none palpable.

The horse reacted negatively to 25psi on the hoof testers to the RF, lateral bar about 2 months ago. The vet was out and was able to duplicate the reaction in the same location, but radiographs of that foot were clean. There was no infection in the foot, nothing diseased or poor, and the vet deemed it "inconclusive." The next trim was 4 weeks later, and the horse was non-reactive to testers at that time.

egontoast - yes, in the past - not in the last year. Vet called a little bit ago, said the 3 stifle radiographs were fine, nothing to note. So now the horse will be going to Oconomowoc for ultrasound, and whatever other diagnostics they feel are needed.

[Simkie]

Sounds like it's time for scintigraphy

YES.

Blush's history is quite similar. Passed/barely failed a neuro exam--most vets would have called her normal. Hind end lameness due to bony changes in the c-spine that initially looked JUST like hocks. I imagine that if I had not done the bone scan when I did, I could have spent years chasing it, like it sounds your friend has.

[deltawave]

is claudication seen very often in horses?

I can't give you prevalence/incidence, I'm not a vet, but vascular insufficiency (aortic thrombosis, saddle embolism, etc.) is not unheard of.

As regards the limb, where would it be most likely to occur?

Depends on where the arterial stenosis/occlusion is. The more proximal the problem, the more of the limb/girdle you'd expect to see affected.

Is it not also a possibility that the lameness could be related to a neurological claudication caused by a stenois of the spinal canal and/or compression of the root of the nerve?

Can't answer--I have no idea if horses suffer from spinal stenosis or are prone to that sort of mechanical issue, sorry.

One thing about vascular pain--it is pretty darn predictable, as I mentioned above, unless of course it isn't and/or the vascular "issue" is an evanescent, waxing and waning sort of thing. Still, a good exam of the pulses before and after exercise should be very revealing. I wouldn't think vascular pain would persist for more than some moments after exertion stops.

[Posting Trot]

According to the de-worming schedule you posted, the horse hasn't had a powerpack or used moxidectin in the past 5 years or so. It's possible that encysted strongyles are an issue. Would they make a horse lame? I doubt it, but they could sure account for the unthriftiness.

Also, when were the horse's teeth last done? It's amazing what a cracked tooth can do, both to the way a horse looks and the way he moves.

Finally, I don't know where you're located, but lyme disease is often worth investigating, particularly in NQR/shifting and recurring lameness situations.

Good luck.

[egontoast]

Are these the dreaded hoofworms I wonder? Much like the ice worms of the Great White North.

[ChocoMare]

Let's ask two questions first:

1- In that geographical area, are gnats/no-see-ums prevalent from spring till first frost?

2- Has this horse shown a tendency towards the most common sweet-itch tendencies?

[matryoshka]

This isn't terribly helpful, but one horse I trimmed developed a strange hind-end weakness that was not neurological. Vet ruled out EPM and Lymes. Did a sonogram and found a tumor in the mare's chest, which turned out to be cancerous and fast growing. Very sad.

[Fharoah]

Well you could try a panacur powerpack. If nerve blocks are unsecessful in iscolating the lameness you may want to do a bone scan.

[EqTrainer]

Considering the horse has never been powerpacked and has never been dewormed w/Moxidectin, I wonder what the state of his immune system is. Sounds like maybe he is losing the battle. Can't hurt to try.

[FlashGordon]

Well I don't know.... has she done a blood panel? Tested for Lyme? Looked into possible metabolic issues?

Sort of sounds like my own horse, whose back end I just cannot get right, and whose weight fluctuates. Among some other "interesting" things. I've long suspected he has internal damage from worms, as I doubt he was de-wormed regularly the last 7-8 years. And who knows about before that.

There are some things that, in my opinion, have not been entirely figured out. Worm infestation and its affects on the equine system being one. Or maybe it has, but the knowledge has not yet trickled down to the average vet or joe schmo owner.

Anyway hope the horse improves....

And if all else fails, turn him out for a year.