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4yo WB Lameness - UPDATE NEURO

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    4yo WB Lameness - UPDATE NEURO

    TLDR – unsolved lameness in 4yo WB gelding. One vet thinks sticky stifles, one vet thought suspensory strain last year, now thinks neurologic. Horse does not seem neurologic to me. Not sure what to do next.

    Horse in question (Hermes) is a 4yo WB gelding, coarse type, South Pacific lines, almost looks like a draft cross. I bought him as an unhandled 2yo colt – I was hunting for a ‘deal.’ Only evaluation was watching him move in a 150’ x 150’ drylot with 10 other horses. Also saw short video, mostly canter and free jumping. I noticed in the free jumping video when the horse is traveling away from the camera that he swings his hind legs wide when bringing them forward; my coach chalked it up to ‘tension’ since the handlers were chasing the horse. In real life the horse looked sound, loose/comfortable in his body, lofty movement, I took a gamble, brought him home in March 2018.

    Horses live at home and are out 24/7 – so I have ample opportunity to watch. During 2yo year we got him gelded and worked on halter/groundwork, proper hoof care, etc. Noticed that he normally tracks wide behind, but didn’t seem lame. Does drag both hind toes a little at the walk but not enough that the toes are rounded (barefoot). During 3yo year started him undersaddle in June 2019, he got hurt in September 2019. Injury was definitely LH, looked almost like cellulitis at first (although no sign of broken skin) so I treated with SMZs and sweat wrap, no resolution so I had my Normal Vet out. No response to flexions, seemed sensitive over head of suspensory but ultrasound machine not available, thought maybe fractured splint, but nothing on xray. Vet also thought horse could be slightly neurologic, but didn’t do any of the typical tests (tail pull, etc.). Vet thought maybe horse had slight suspensory strain we agreed to restrict the horse to the dry lot for 6mo, but didn’t go for stall rest. I don’t have stalls, it would have been difficult to manage on our farm. Dry lot is big enough for horses to WTC so not really like stall rest but better than full run of hilly pasture. Over the winter I noticed that the LH fetlock seemed dropped relative to other horses and relative to Hermes’ RH.

    Re-evaluated Hermes myself in May 2020 (horse is now 4yo) and he still wasn’t quite right. Took him to ‘best’ lameness vet in our area who is also regular vet’s professional mentor. Hermes did not have a response to flexions, but did have some puffiness/swelling around stifles. Fancy Vet performed a few neurologic tests walking/tail pulling, reflexive response by running pen down rump. I asked if he thought the horse was neurologic, he said no. I asked if he thought the slightly dropped fetlock could be indicative of suspensory and he said horse would be much more lame if suspensory was at play. Fancy Vet thought stifle OCD, but stifle xrays were clean. Fancy Vet was very confident about ‘sticky stifle’ diagnosis and instructed me to give 2g of bute/day for 2 weeks, march up and down hills at the walk to strengthen hind legs. I didn’t do the bute – seemed too severe, but I did put him on daily equioxx and MSM. We spent the summer marching up and down hills – lucky that we have good hills on the property. Also walked over raised cavaletti. Seemed to improve a little, but still toe dragging, still lame on LH even with daily equioxx. When cantering to the right swaps out behind as he’s coming down to the trot.

    I wanted to understand what I should ‘expect’ from Hermes. Should I resign him to walking trail horse only? Is walking trail horse too strenuous and I should retire him to pasture? I had Normal Vet out this week (September 2020). Vet watches horse walk and jog in hand. Palpated around SI, no response. Picks up hind hoof and brings hoof forward under body and holds for 30 sec (like farrier hoof stand position). Says he thinks horse is Grade 2 neurologic b/c horse feels unstable (like he could push him over) when holding up hind hoof in this position; worse on LH side. Pulls blood to test for EPM. Says next steps would be $750 for neck xrays and potentially inject. Says nothing about suspensory (and I forgot to ask).

    I love Hermes – he is a total clown, extremely curious, and the smartest and most human engaging horse I have ever met; he has a permanent role on this farm and will be with us as long as he’s comfortable. I watch him play with the other horses and he’s extremely athletic and seems very coordinated – canter pirouettes, rollbacks, flying changes every day. He can step over raised cavaletti without touching them and can have a lot of suspension in his gaits where hinds don’t drag…but still drags hind toes if he’s just walking around the paddock. His athletic antics make it hard for me to believe he’s neurologic or uncoordinated – but I have no experience with neurologic horses. I want to understand his diagnosis/limitations, but I also don’t want to spend $$$ (another $750 isn’t bad, but what if neck xrays are clean, then what?). I still suspect suspensory but I’m not sure that explains toe dragging as 2yo before lameness. Suggestions?
    Last edited by NaturalSelection; Sep. 24, 2020, 03:03 PM.

    #2
    For me, without knowing the type of practice Fancy Vet is a member of, I don't know that I'd made a definitive decision yet. Is there a practice in your area known for lameness evaluation and workup?

    Is there a vet school within hauling distance you could perhaps take him to.

    I'm not convinced that the evaluation he's had done is extensive enough to make a career call at this point.
    Oh, I have slipped the surly bonds of earth, And danced the skies on laughter-silvered wings; John Gilliespie Magee, Jr

    Comment

      Original Poster

      #3
      Good feedback. Fancy Vet is widely regarded as ‘the best’ lameness vet (specialization in lameness/orthopedic) in the Twin Cities. I am close to the U of MN vet school. I think they’re comparable on lameness, potentially better for neurologic diagnosis. I think a visit to the U of MN could be next step.

      Comment


        #4
        These symptoms are not exactly uncommon with early EPSA/DSLD. I'm hoping that's not the case for your guy; ultrasounding the suspensories would be my next step personally, since it sounds like after the initial possible suspensory tweak, there weren't any definitive diagnoses.
        AETERNUM VALE, INVICTUS - 7/10/2012

        Comment


          #5
          I, too, wondered about DSLD when you mentioned the hind looked a little dropped. I sure hope not.

          I would for sure spend the money and time to send him to the vet school or best sports-medicine vet you can find and get some high-tech diagnostics done.
          A good man can make you feel sexy, strong, and able to take on the world.... oh, sorry.... that's wine...wine does that...

          http://elementfarm.blogspot.com/

          Comment


            #6
            I too was going to suggest DSLD, others beat me to it. Often it presents in the early stages as the sort of thing you just can’t quite pinpoint.

            On the complete opposite end of the spectrum, has he had his sheath cleaned and bean removed lately?

            Comment


              #7
              The tracking wide behind was a symptom of my horse's chronic SI instability/joint disease. That also caused some toe dragging. It presented as some mild circumduction of the outside hind limb on a circle and mild toe drag (but mostly he did that walking lazily in turnout). A wide sort of swinging expression to the gait behind on a straight line. Dressage people went oooh! Vets said hmmmm. In any event, what you saw as a 2yo may not be related to the lameness but may be a different abnormality that could be performance limiting or cause some chronic pain if you get him in hard work. I think my horse had a flip over kind of event as a yearling or 2 yo maybe while being caught in some wire. He also had neck stuff but that caused other issues and he was not neurologic. Exceptionally athletic, but did have chronic issues.

              But I'd be more concerned with your horse about LH given dropped fetlock and persistent lameness on that one leg. A lot of vets will poo-poo a suggestion that a 4yo would have DSLD, but some posters here have had experience with young horses having that. And I went to look at a 4yo last year that had one hind fetlock nearly parallel to the ground (other leg was fine), and he was clearly NQR and expressing that by being very poorly behaved under saddle (which I watched because I was evaluating him for someone else and wanted to give them a full story--if it was for me, I would have walked as soon as I saw him standing to be tacked).

              Was that leg ever ultrasounded? Could you take some photos so we can see him standing square from the side and behind?

              Comment


                #8
                Originally posted by NaturalSelection View Post
                Good feedback. Fancy Vet is widely regarded as ‘the best’ lameness vet (specialization in lameness/orthopedic) in the Twin Cities. I am close to the U of MN vet school. I think they’re comparable on lameness, potentially better for neurologic diagnosis. I think a visit to the U of MN could be next step.
                Not saying Fancy Vet is bad for sure, but your vet has learned from Fancy Vet so, I am guessing, some commonalities. Maybe time, as you suggested for a different POV and with access to a vet school, a chance for fresh eyes.

                Sometimes a problem just needs someone else to look at it.

                DSLD also crossed my mind but so many possibilities. Hope it isn't DSLD


                Oh, I have slipped the surly bonds of earth, And danced the skies on laughter-silvered wings; John Gilliespie Magee, Jr

                Comment


                  #9
                  the wide behind and the odd jump form should be brought forward again. The toe dragging would make me worry both about neck and SI. The lax fetlock , yup that is worrisome . The current research to the genetics of the condition which is more than an issue with legs will be something for the future, but vets at the vet school might have some inside insight.

                  Personally, at such a young age I would invest in a trip to the vet school and some top notch imaging.
                  _\\]
                  -- * > hoopoe
                  Procrastinate NOW
                  Introverted Since 1957

                  Comment

                    Original Poster

                    #10
                    Good advice! I agree LH suspensory needs investigation, no ultrasound has been done so far. Going to call the vet school this morning. I’ll report back!
                    Thanks.

                    Comment


                      #11
                      Natural Selection, My horse had toe dragging, especially on one hind as a youngster. His stifle x-rays were clean. He is extremely athletic like yours, but was short in the stride on that same hind while also eventually collapsing in downward transitions. Lameness workup #1 blocked to the stifle and Ultrasound showed OCD lesion at the medial trochlear ridge. Arthroscopic surgery showed frayed cartilage and lesions on the patella. The joint was cleaned up, and the stifle collapse/buckling on downward transitions were cured. Unfortunately we worked the hind end for muscle tone because he was originally diagnosed with Intermittent upward fixation of the patella.

                      The short stride did not resolve, for three years while, I was told he was fine, unfortunately. Did not know nerve blocks typically are done from the bottom up. Finally, had a new lameness work up, #2, and discovered the horse had an old and now chronic suspensory injury. Everything fell into place. He got treatment this last spring, and so far, so good.

                      Your horse may present as one thing or another, but sometimes the story has yet to be revealed. More data from history from you and good diagnostics from an experienced and skilled lameness vet might shed some light on what is bothering your horse.

                      Comment

                        Original Poster

                        #12
                        Click image for larger version

Name:	44856AE7-9BAA-4744-9DC1-D47DAC41E6AF.jpeg
Views:	534
Size:	21.2 KB
ID:	10738496 We have an appointment for Oct 7th. Great advice and support here, I really appreciate it!

                        I don’t take a lot of photos, but here are two of Hermes.
                        Attached Files

                        Comment


                          #13
                          Keep us posted. I think a fresh set of eye and a complete diagnostic workup will give you more information about what is going on.

                          He looks like a sweetie!
                          Oh, I have slipped the surly bonds of earth, And danced the skies on laughter-silvered wings; John Gilliespie Magee, Jr

                          Comment

                            Original Poster

                            #14
                            Update!

                            EPM results came back in the ‘grey’ - exposure, but doesn’t seem like currently a raging antibody response.

                            My normal vet consulted with the fancy lameness vet and now they both think the horse is neurologic since he didn’t respond to strengthening work over the summer. My vet supports neurologic as root cause by pointing out some hind end muscle atrophy and does not think the horse is lame enough to respond to nerve blocks and does not think lameness looks like suspensory as horse does not seem to be avoiding bearing weight. As for next steps we could X-ray neck and if nothing on X-ray go to the U of MN for myelogram. I have not proceeded with this because my vet doesn’t think we will find anything we can treat as he considers neck arthritis to be unlikely.

                            Two weeks ago I started Hermes on 2000 IU/day of VitE and 1oz/day of MSM (in addition to his standard 1.5 lbs/day of TC ration balancer and free choice grass/Alf hay). I just returned from a week away and I see a noticeable improvement in his gait and most noticeable is that his droopy lower lip has stopped drooping! This makes me more confident in a neurologic condition. I am going to try increasing VitE to 8,000 IU/day to see if this provides additional improvement.

                            Has anyone seen improvement from treating an old case of EPM?

                            Does the MSM or VitE response point to a particular neurologic diagnosis? I suspect the VitE is the cause for change as I had previously tried daily equioxx, which should have provided some anti inflammatory benefit, but did not see any improvement.

                            Thanks,
                            Katie.

                            Comment


                              #15
                              I’d get that neck looked at...

                              Comment

                                Original Poster

                                #16
                                Xanthoria thanks for your response.

                                I’m curious if investigating neck further would change course of treatment - do you have any experience here? My vet thinks finding arthritis and injecting neck is an unlikely outcome. If Hermes is a more traditional a Wobblers case, even if surgical I am not going to proceed with surgery - too risky and expensive.

                                Comment


                                  #17
                                  My EPM guy was on 10,000 IU of NATURAL Vit E - make sure it is natural not synthetic. Also MSM.
                                  www.settlementfarm.us

                                  Comment


                                    #18
                                    Originally posted by NaturalSelection View Post

                                    Two weeks ago I started Hermes on 2000 IU/day of VitE and 1oz/day of MSM (in addition to his standard 1.5 lbs/day of TC ration balancer and free choice grass/Alf hay). I just returned from a week away and I see a noticeable improvement in his gait and most noticeable is that his droopy lower lip has stopped drooping! This makes me more confident in a neurologic condition. I am going to try increasing VitE to 8,000 IU/day to see if this provides additional improvement.
                                    Any bloodwork for E and Se levels?

                                    Has anyone seen improvement from treating an old case of EPM?
                                    EPM is about nerve damage. Nerves can regenerate. How well that happens depends on the age of the horse, and the extent of the damage. So a young horse with a potentially mild case has good chance

                                    Does the MSM or VitE response point to a particular neurologic diagnosis? I suspect the VitE is the cause for change as I had previously tried daily equioxx, which should have provided some anti inflammatory benefit, but did not see any improvement.
                                    MSM no, unless the neuro symptoms were from some relatively mild inflammation, which is unlikely, though I suppose possible

                                    E, yes. Equine Motor Neuron Disease absolutely presents as muscle atrophy, weakness, and weight loss. It's caused by a long-term Vit E deficiency.

                                    But a low enough E level doesn't have to present as full blown EMND

                                    What was his diet when you got him do you know? I know you said he's been "out 24x7", and appear to be in WI, so I assume that means he's has grass for at least several months each year you've had him? What's his diet now?


                                    ______________________________
                                    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                                    Comment


                                      #19
                                      Originally posted by NaturalSelection View Post
                                      Xanthoria thanks for your response.

                                      I’m curious if investigating neck further would change course of treatment - do you have any experience here? My vet thinks finding arthritis and injecting neck is an unlikely outcome. If Hermes is a more traditional a Wobblers case, even if surgical I am not going to proceed with surgery - too risky and expensive.
                                      In my guy with cervical arthritis the diagnosis finally told me why he was having so many neuro symptoms and multiple vets missed it. He was getting 10,000IU of natural vit E and MSM and. Host fo other things for years before that. The supplements helped a lot with his PSSM but finding out it was CA meant I sadly had to euth him: it wasn’t a static, hronic issue but something progressive. If I had known sooner I wouldn’t have tried some of the things I did, I probably wouldn’t have ridden him, and I might have tried joint supps or other treatments like injections before it was too late. He ended up with two suspensories that were treated with IRAP and shockwave which, again, I could have skipped...

                                      Comment

                                        Original Poster

                                        #20
                                        Hermes has been on good pasture this year (2020) from May-Oct. In 2019 he was away getting started undersaddle and then boarded from June-Sept so I could have a more structured facility to ride, no pasture. In 2018 not a lot of pasture as we were still building fence. Always out in drylot. I just researched and we are in a low Se county of WI and all the hay I feed is harvested from our field. Going to add a Vit E/Se supplement. The Vit E I am using now is the human Nature Made capsules. Edited to add, no bloodwork or hair sample so far for Vit E or Se levels.

                                        I don’t think his nutrition was very good from 0-2yo. Backyard breeder with way too many horses and he was not halter broken and had never had his feet trimmed when I got him as 2yo colt in March of 2018.

                                        I feel awful that I didn’t address this earlier, I just chalked up droopy lip and funky gait at the walk to ‘who he is’ and didn’t recognize that they are markers of neuro.

                                        Comment

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