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How does your vet evaluate for lameness?

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  • How does your vet evaluate for lameness?

    Is it simply watching under tack? Or that, plus flexions? How 'bout back palpations? utilizing acupressure points? When does he involve blocks? How accurate are these blocks ie: is he able to determine lameness with one or two, or does he continue to block up 'until he finds it'? How many times are your blocks 'missed'?

    I've had experience with several vets recently and am amazed by the various methods utilized to find a sore limb. Can't say more -- don't want to stir the pot in my life who might know me here. Curious about your experiences, though.

    Thanks.

  • #2
    First he/she ought to take a history: did something obvious happen? How long has the horse been lame and did it start all at once or gradually? Did the owner/rider notice anything at the time it was first seen? Has there been heat? A pulse? Any prior history of lameness, shoeing problems, recent changes in work, footing, shoes/trims?

    Then he'd examine the animal, looking for the obvious, the not-so-obvious, the subtle . . . gross swelling, hoof testers, pulses, heat, muscle wasting, deformity, hoof/shoe wear, wounds, etc. Compare everything with the unaffected limb. Often shoes need to be pulled to allow a complete exam.

    Next it's time for the animal to move--start out being led at the walk on hard then soft surfaces, circles, turning tightly from one side to the other. Maybe next jogging or on the longe line, hard and soft footing. Sometimes it's best evaluated under tack, especially if it's a subtle hind end/back problem. After this, maybe another look at an area that's been narrowed down.

    Once you've got it narrowed down some, often flexions and nerve blocks are next. Flexions are pretty obvious, and if you localize a lameness that way you may not need to block. If you do block, though, usually you'd start way down distally, blocking the heel and hindfoot, then work your way up until there is an obvious change in lameness (going back to whatever made the horse obviously lame, whether it be hard, soft, trot, whatever). It takes time; sometimes nerve blocks take several minutes to take, and a horse needs to not only figure out that the foot/leg now feels funny, but also that it doesn't HURT any more. Limping can take a while and a lot of patient observation to quiet down with a good nerve block. Obviously blocking doesn't do any good if the horse is not lame at that moment.

    Then it's often time for X-rays, although sometimes you go right to those if a bony deformity or abnormality is obvious or the history suggests it. If you have to sedate the horse you can do it now, since most of the stuff that requires moving the animal is done, and some horses object or are difficult with positioning for films. Obviously you'd rather not sedate a horse that needs to be jogged, so nerve blocks are sometimes tough on a difficult animal.

    If you've got your answer at this point, you formulate a plan. If not, you might move on to more advanced imaging.
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    • #3
      deltawave gave a very complete answer, and that's what I've always seen done. General history (which leg is suspect?), walking/trotting up & down on soft ground & concrete in hand, sometimes longing (but not often in my experience), then palpation (hoof testers, looking for joint effusion, pain, etc), then radiographs to definitively rule out bone involvement.

      A few notes:

      I've never had a horse evaluated for lameness under tack. If they're lame enough to be seeing a vet, they probably shouldn't be ridden.

      As for your question regarding nerve blocks, the accuracy does depend on the horse and the vet doing them. The local anesthetic may migrate and block nerves that weren't intended to be blocked. If the horse isn't standing stock-still, they may miss the nerve. We spent a year trying to localize pain in one of my gelding's forelimbs (before finally springing for the MRI to nail down a diagnosis of a ligament tear), and he developed so much scar tissue from being blocked that it's hard to get a good one now. However, in my experience, it is almost always effective enough to at least have an idea of where the pain is. Perhaps the horse may not go totally sound, but sound "enough" to be able to say "yes, the pain is in the hoof, but he may still be a little lame because my block was a little too low, or he didn't get the full dose, or we didn't leave enough time for the block to sink in, or we left too much time before assessing and now the block is wearing off."
      And you don't want to block above the knee/hocks, or else the horse'll lose function of that leg. The most common nerve block by far is the palmar digital nerve (PD), along the pastern, to block out the hoof. If there are problems more proximally, you will almost always see other clinical signs (swelling, effusion, heat, pain with palpation).

      If rads are clean, the vet'll move to ultrasound (assuming they think the damage is above the hoof) to try to identify a lesion in tendon or ligament.

      Acupuncture and the like, if used, are usually included in the treatment, not the diagnosis.

      Comment


      • #4
        As DW said. My vet though almost always wants to see the horse under saddle. And he'll do flexions under saddle. Just because the horse is lame enough to see a vet, doesn't mean he shouldn't be ridden for the evaluation. My horse's lameness was very subtle on the lunge. You couldn't really see it. It was really only under saddle that it was more obvious (a suspensory injury). On the lunge he'd w/t/c, under saddle, no way. I think evaluating the horse under saddle is a very beneficial, often under utilized part of the exam. I vetted a horse a few weeks ago and the vet told me she (she's part of the same practice as my primary vet) had never seen horses evaluated for lameness under saddle until she joined the practice, and she thought it made a big difference. (And this way too when the horse flexed positively, I was able to feel it as well.)

        Comment


        • #5
          Originally posted by WishIWereRiding View Post
          As DW said. My vet though almost always wants to see the horse under saddle. And he'll do flexions under saddle. Just because the horse is lame enough to see a vet, doesn't mean he shouldn't be ridden for the evaluation. My horse's lameness was very subtle on the lunge. You couldn't really see it. It was really only under saddle that it was more obvious (a suspensory injury). On the lunge he'd w/t/c, under saddle, no way. I think evaluating the horse under saddle is a very beneficial, often under utilized part of the exam. I vetted a horse a few weeks ago and the vet told me she (she's part of the same practice as my primary vet) had never seen horses evaluated for lameness under saddle until she joined the practice, and she thought it made a big difference. (And this way too when the horse flexed positively, I was able to feel it as well.)
          I agree... my horse did this once. We did all the other stuff first and it really only showed up when he was ridden u/s.

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          • #6
            I just recently went thru this with my horse. The vet took the history and then asked if she should lunge or go under saddle. We tried lunging first as her lameness was showing even at the walk(slightly). Progressed with jogging, lunging, hoof testers, flexions. Her hocks were sore so they got injected. I had been feeling something front end, but nothing really showed up. Got the hocks done and about 2 weeks later, she was again showing front end lameness. Back to the vet and leg was blocked, and area pinpointed. Back to vet the next week for ultrasound.

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            • Original Poster

              #7
              Thanks guys...

              So, how do you consider Lyme?

              I've been told various acupressure points can 'light up', along with migrating lameness unresponsive to NSAIDs. Usually blood is drawn and sent for titer when the NSAIDs are prescribed, if he's still lame, then some will start doxy prior to confirmation with high titer or Western Blot.

              You?

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              • #8
                How do consider Lyme? Draw a titer, start on doxy and see what you get.

                Comment


                • #9
                  Originally posted by WishIWereRiding View Post
                  As DW said. My vet though almost always wants to see the horse under saddle. And he'll do flexions under saddle. Just because the horse is lame enough to see a vet, doesn't mean he shouldn't be ridden for the evaluation. My horse's lameness was very subtle on the lunge. You couldn't really see it. It was really only under saddle that it was more obvious (a suspensory injury). On the lunge he'd w/t/c, under saddle, no way. I think evaluating the horse under saddle is a very beneficial, often under utilized part of the exam. I vetted a horse a few weeks ago and the vet told me she (she's part of the same practice as my primary vet) had never seen horses evaluated for lameness under saddle until she joined the practice, and she thought it made a big difference. (And this way too when the horse flexed positively, I was able to feel it as well.)
                  I wonder if this would have helped my horse. ON the first vetting, my horse wasn't lame enough for the vet. I had to ride my horse to make lamer for second vet apt. Ugh, a suspensory.

                  Comment

                  • Original Poster

                    #10
                    Originally posted by WishIWereRiding View Post
                    How do consider Lyme? Draw a titer, start on doxy and see what you get.
                    It would be helpful if those who choose to contribute could do so in a helpful way. Please re-read for comprehension, then respond accordingly, if your'e able.

                    Comment


                    • #11
                      http://www.netpets.com/horses/healthspa/lyme.html

                      Lyme is quite difficult to diagnose...if you've ruled out everything else, WIWR is quite right... If ever you have a better idea, why don't you say so? Explain more of your accupressure answer you are looking for?!
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                      Originally posted by LauraKY
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                      • Original Poster

                        #12
                        So.. you just look at a horse and say "Hey! I think we'll pull blood for lyme!" with no further qualities being met? No migrating lameness, no intermittent crankiness, exercise intolerance, or perhaps inappetence?

                        Nope. Just start randomly pulling blood and treating.

                        Maybe I'm crabby today, but I thought I was pretty clear. And insofar as 'draw a titer, start doxy, see what you get', I'd really like elaboration of a timeline, or again -- symptoms. You pull blood & start doxy the same day? Then, if horse's symptoms subside after being on doxy, then 'you know what you've got?' Does this consider that doxy has some anti-inflammatory properties that might lessen arthritic issues? What symptoms initially made Lyme disease suspect in the first place? What was the timeline you allowed before you decided the doxy must be fixing it for sure, and it wasn't anotherwise chronic, but now-healed low-grade injury? If the lameness doesnt' subside, when to you employ other methodology (ie: routine NSAIDs, rest, therapeutic treatment) vs. diagnostic imaging?

                        Lastly, as I understand it, there *are* certain points along the horse's body that do indicate lyme disease.. however I'm not an acupuncturist, nor have I had the chance to pick brains of those who use acupuncture to diagnose.

                        Thanks.
                        Last edited by Sansena; Aug. 7, 2010, 08:13 AM. Reason: typo

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                        • #13
                          there *are* certain points along the horse's body that do indicate lyme disease
                          With what degree of accuracy and reproducibility? Even if accupressure points were accurate, valid and well studied, (they aren't) Lyme disease is so variable in its manifestations that I'd have a very tough time buying an iron-clad diagnosis made in this manner.
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                          • #14
                            Originally posted by deltawave View Post
                            With what degree of accuracy and reproducibility? Even if accupressure points were accurate, valid and well studied, (they aren't) Lyme disease is so variable in its manifestations that I'd have a very tough time buying an iron-clad diagnosis made in this manner.
                            Acupressure practitioner here: This is actually a good observation. Yes, certain acupressure/acupuncture points will react in some horses with Lyme. You will also get a reaction in some horses without Lyme, with other conditions, or with no disease condition whatsoever. It can be helpful as part of an overall veterinary diagnosis, and I know several vets that do use acupuncture in this manner. But alone, no, not reliable for diagnosis. Acupressure/acupuncture can also be helpful in relieving some horses' symptoms, but cannot be considered a treatment for disease; that requires a veterinary diagnosis and proper drug therapy.

                            To Sansena: Yes, you can draw blood to test and start doxy the same day. This sort of "treat to diagnose" was really common when I was in VA, in an area where Lyme was a frequent horsey complaint. The idea is that (1) if it is Lyme, starting treatment sooner gets the horse relief sooner, and (2) the response to the doxy may come faster than the test results. In the handful of cases with which I am personally familiar, the titers came back very, very high, indicating almost certain active Lyme infection, in the horses that responded to doxy pre-test-results.
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                            • #15
                              Originally posted by Sansena View Post
                              It would be helpful if those who choose to contribute could do so in a helpful way. Please re-read for comprehension, then respond accordingly, if your'e able.
                              You know, you don't have to be so nasty. Read what you wrote. I thought it was already implied that the horse had some kind of lameness issues, so the next step you were asking was how to consider Lyme? In which case I answered. Gees.
                              There're no findings that are specific for Lyme, i.e. you examine the horse and say, oh, he's got x,y, and z, must be Lyme then, bingo! No, it doesn't go that way. Often people test for Lyme because the picture isn't clear. There's a change in behavior--maybe the horse is unwilling to work, spooky, stopping at jumps, etc. Or migratory lameness, as you said. There's nothing specific. I'm in the same parts of you, and often vets draw a Lyme titer as part of a lameness workup, especially in cases where the picture isn't clear. And yeah, you do draw the blood and start doxy for 10 days because it takes 2 weeks for the titer to come back. If you see a change for the better and the titer is positive, then often you continue the doxy. If you don't see a change, or the titer isn't what you expected it to be then you keep looking.
                              Last year my horse was diagnosed with a suspensory injury. When he first presented he was "lame all over" according to the vet. He didn't know where to block because he flexed + everywhere. He had some hyperesthesia along his back, so we drew a Lyme titer (which I knew would be + because he had had it before, as most horses up here have) and started him on doxy. He didn't get better, and his titer wasn't what the vet thought it would be if the symptoms were due to Lyme. Now, long story short, it wasn't Lyme, but a suspensory injury, which was diagnosed after doing a bone scan and then blocking the limb that lit up the most.
                              Anyway, I was contributing in a helpful way--that's what most vets up here do. Draw a titer, start doxy, and see what you've got. I've done it before as have many others in my barn.

                              Comment


                              • #16
                                Originally posted by Sansena View Post
                                So, how do you consider Lyme?

                                I've been told various acupressure points can 'light up', along with migrating lameness unresponsive to NSAIDs. Usually blood is drawn and sent for titer when the NSAIDs are prescribed, if he's still lame, then some will start doxy prior to confirmation with high titer or Western Blot.

                                You?
                                A good chiro/accupunturist can use the acupunture points for lyme to see if there is a reaction. I might use that as an initial diagnosis if I suspected lyme before I called my vet out for a titre, but on the same token most chiros/accus worth their salt will tell you it's not 100% accurate and to still seek bloodwork from your regular vet.

                                Lyme does not always have migrating lameness. Yes that is often a tell tale sign but I have known quite a few horses with lyme that have displayed lameness limited to one area or even no lameness at all.
                                Unresponsive to NSAIDS does not neccessarily indicate lyme either IME. I have heard people say that but according to my vet it is not factually based at all and should not be part of a veterinary diagnosis.

                                Most good vets don't just start dosing Doxy without getting test results first. Mine won't. She won't even prescribe the Doxy for horses whom have had lyme in the past without a retest of BOTH titre and WB. A lyme test with just one or the other is really inconclusive (lyme is difficult to pinpoint to begin with, why make it more difficult). It is imperative to send the blood to a testing facility like Cornell or Uconn that will test for both WB AND the Elisa titre assess the results, review the symptoms and then go from there with treatment.

                                For extreme cases of lyme my vet recommends a course of IV Oxy tet versus the oral doxy.

                                Comment


                                • #17
                                  [quote]
                                  Originally posted by WishIWereRiding View Post
                                  Often people test for Lyme because the picture isn't clear. There's a change in behavior--maybe the horse is unwilling to work, spooky, stopping at jumps, etc. Or migratory lameness, as you said. There's nothing specific.
                                  agreed.

                                  .
                                  And yeah, you do draw the blood and start doxy for 10 days because it takes 2 weeks for the titer to come back.
                                  I'm in CT (lyme country) and I have treated for lyme 3 times now (tested 4 times) between my two horses. Never once has it taken 2 wks for test results. Maybe a week max? Where are your vets sending the bloodwork
                                  My vet has also never recommended starting doxy BEFORE examining the test results first, I know because I have asked to start it beforehand when I suspected the issue was lyme.
                                  Her reasoning is that Doxy has anti-inflammatory effects and a horse suffering from a completely unrelated issue can seem "better" when in fact Lyme isn't the real culprit and once they are off the doxy the symptoms return shortly thereafter.

                                  That said, alot of vets around here don't know as much about lyme as they should considering we are in an endemic area and they treat horses purely based on response to Doxy and will gladly start on the doxy long before test results come in. Some don't even require bloodwork before starting doxy.

                                  Comment


                                  • #18
                                    We got a 2nd opinion yesterday and it was very similar to what Deltawave wrote. But we had already tested 2X for Lyme and Mick was negative.
                                    We also had the lameness narrowed down to his left front shoulder/leg.

                                    The vet took a history, then walked, circled and trotted the horse on the hard-packed dirt parking lot. Yep, the horse was lame in the front left leg.

                                    Flexed all round, used hoof testers, then decided to start blocking, first low, waited 10 min, walked, trotted, flexed, still lame, decided to block a bit higher.

                                    walked, trotted, flexed sound but not 100% because Mick didn't want to trot anymore. so he got lunged in ring and was 100% sound.

                                    Next was the ultrasound. Turns out Mick has a hole in his suspensory. Even the that was difficult to see.But the vet was patient and had to flex Mick's ankle to see it at first.

                                    So while the vet was prepared to watch the horse being ridden, it wasn't necessary.

                                    But if it was, the vet was willing to go that route.
                                    The whole time, I could see the wheels churning as the vet tried to fit all the pieces and he never hurried nor skipped a set. walked and trotted and flexed the horse each time a block was done.

                                    Comment


                                    • #19
                                      [QUOTE=LookinSouth;5024251]

                                      I'm in CT (lyme country) and I have treated for lyme 3 times now (tested 4 times) between my two horses. Never once has it taken 2 wks for test results. Maybe a week max? Where are your vets sending the bloodwork
                                      My vet has also never recommended starting doxy BEFORE examining the test results first, I know because I have asked to start it beforehand when I suspected the issue was lyme.
                                      Her reasoning is that Doxy has anti-inflammatory effects and a horse suffering from a completely unrelated issue can seem "better" when in fact Lyme isn't the real culprit and once they are off the doxy the symptoms return shortly thereafter.

                                      That said, alot of vets around here don't know as much about lyme as they should considering we are in an endemic area and they treat horses purely based on response to Doxy and will gladly start on the doxy long before test results come in. Some don't even require bloodwork before starting doxy.
                                      I'm also in CT, and my vet is excellent and well versed in Lyme and lameness issues. He is very well respected and treats many of the Olympic athletes around here. (He also works out of one of the referral centers around here for equine care, surgery, etc.) It think he has us start on doxy right away because so many horses will test positive, the question isn't if the titer is +, it's what's the number. I also don't think doxy has enough of an anti-inflammatory effect to really mask anything--it certainly didn't with my horse. And it's not like he's holding a gun to my head, saying "start the doxy, don't wait for the titer." It's an option that many of us choose. I know plenty of people that draw a titer and wait for the results. With my last horse there wasn't any lameness, just a change in behavior (more ring sour, not wanting to work, etc), which is why we started doxy before getting the titer results (which I knew would be + b/c he had a history of Lyme).
                                      I guess I should have said that it can take up to 2 weeks to get the results--I believe they run (at U. Conn) the blood work in batches (maybe this has changed). Although last year I did get my results in a week. But my point was say you have the vet draw the titer on a Friday, it will be Monday before the blood gets to U. Conn, and probably the following week you get the result.

                                      Comment

                                      • Original Poster

                                        #20
                                        Originally posted by deltawave View Post
                                        With what degree of accuracy and reproducibility? Even if accupressure points were accurate, valid and well studied, (they aren't) Lyme disease is so variable in its manifestations that I'd have a very tough time buying an iron-clad diagnosis made in this manner.
                                        Just as someone -hopefully- wouldn't simply start on doxy because of lameness, one doesn't decide upon a Lyme diagnosis b/c some acupressure points are hot, alone. It's one component of the Lyme diagnosis... or other lameness diagnosis for that matter.

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