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What to do? Bone scan? Nerve blocks? Ugh!

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  • What to do? Bone scan? Nerve blocks? Ugh!

    To sum up earlier posts: my 11 yr old Connemara mare has been NQR in her hind end as long as I have had her, 4 years. I bought her from a friend who had bought her sight unseen on the recommendation of someone she really trusted. She came off the trailer lame. It was a real fishy deal and her prior history is a mystery except that she has auto changes and is really fancy large pony. It was chalked to being a sticky right stifle (without having any tests done back then) because she is always better with work and about a .5 lame on a bad day but usually sound (in work-much much worse with rest). She moves funny and drags her toes always. I was a horse desperate college kid and bought her because I loved her and didn’t really have the funds to investigate further until now (but not unlimited funds for sure!) She has served me well doing 2'3 hunter stuff and now exclusively dressage.

    Its gotten a bit worse in the past few months so I had the best lameness vet out to check her out. Said he sees what I’m talking about and thinks its hind end something. Did flex tests and she didn’t respond very positive for any of them. We x-rayed hocks and stifles. Hocks and left stifle clean as can be. Right stifle has a tiny bone spur. He looks at them back at clinic on high res and says he doesn’t see anything that really would concern him, even the tiny spur and says to do a 2 week previcox test. In the past two weeks, I have seen a gigantic improvement going down hills while hacking out. No more tail swishing, teeth grinding, and pinned ears. I am getting better lateral work in the ring, and she isn’t resting her right hind exclusively anymore.

    So vet says that since she has had a good response to the previcox that the next step would be to a set of nerve blocks on her right hind to try to narrow down a location of the problem but her lameness is slight and not really easy to see so Im not really sure if I will be able to determine which blocks work and he says that it could be her hips which we really wont be able to determine OR bring her to the clinic for a bone scan which would look at the hips OR do nothing and try legends or use previcox on an as needed basis.

    I really dont know what to do. I feel like I should do the blocks or the scan to try to find out what’s wrong with her so I can make a decision about long term care and treatment options instead of blindly throwing stuff at her and maybe wasting more money.

    I told him Id like to do the blocks and they are supposed to call in the next day or so to schedule an appointment but now I’m second guessing. Should I do the scan or the blocks or do neither and just try the injections? Which is the better diagnostic tool? Money is a factor as we just found out my husband will need back surgery in Feb (yikes) and I just found out that I have to have a few medical things myself that my insurance doesnt cover. So...when it rains, it pours.

    I feel like since she is in pain (because the previcox has made a difference) that I really should try to get to the bottom of this and make the decision to retire her or figure out what I can do to make her comfortable. She has been a good friend and partner to me.

  • #2
    Would either of the diagnostic tests lead you to a massive change in the treatment plan? (for example, would surgery on a stifle be an option or injecting the SI joints if those were the culprit?) If not, it probably would not hurt after this long to simply empirically give the horse a course of Adequan or Legend (no "s"!) or Pentosan and see what happens. If I were financially pinched I would do a course of Pentosan which will cost you <$200 for the whole thing, use NSAIDs as needed and keep working on strengthening that hind end. Better strength via lots of walking, trot poles, and hills would probably do no harm and might do a lot of good. Give her 3 months of that and see what you have--cost minimal. Good luck! (Obviously see if the vet agrees with this amateur's game plan)
    Click here before you buy.


    • #3
      Based on your description it sounds like you had issues going down hills before, which were greatly helped by the Previcox. Based on that and the radiograph, I'd bet its the stifle. However, the toe dragging and the downhill issues could also point to something neurological (or arthritis in the spine). If the horse passes all of the basic neurological tests and doesn't palpate sore in the back or SI, I'd probably inject the stifle, ride and see what you have in 6 weeks.


      • #4
        This is what I would do, not necessarily telling you to do it. I would have the vet inject the stifle and see if that solves the offness. Next I would have the vet inject the S/I to see if that makes improvement. If neither of them help, then .
        Of course, I would have my vet concur in this program as he knows my horse best.

        The fancy diagnostics are great and all if you have the money to put into them. In the end, though, the solution is either maintenance by injecting some joint, or in severe cases retirement.

        As for nerve blocks...that would work ok for the hocks, but blocking the stifle is extremely painful (and dangerous) to do w/o tranquilizing which you can't do if you are planning to ride.


        • #5
          I second delta's post. I'd start right away with pentosan as not only would it help if stifle is the core issue, but all the other joints that have compensated/bared the brunt of the core issue for quite some time. I also have found that a really good chiropractor or even acupuncturist can often pinpoint an issue much less invasively than other methods. The key is to find a really good one!


          • #6
            Just do the blocks and see if it indicates anything, maybe take some pictures if indcated. The bone scan is really pricey, usually requires a clinic visit and maybe an overnite stay. I sure would not do that unless it was absolutely necessary.

            I realize she has improved with the Previcox. But Previcox is a painkiller so something is hurting that is not likely to go away even if you can cover the effects.

            You do the horse no favors if it has an undetected fracture of the hip or pelvis and, sooner or later, the painkillers will not work. We poke, prod and medicate joints, pieces and parts too much without trying to identify and fix the issues causing problems in the effort to just keep them going so we can keep using them. All without being sure we do not do further harm in doing so.
            When opportunity knocks it's wearing overalls and looks like work.

            The horse world. Two people. Three opinions.


            • #7
              Bone Scan

              If you DO decide to go forward with a bone scan, then be sure to do the WHOLE horse, not just the ind end. The cost will be slightly higher, but it's really worth it to get the full picture. What you're describing could very well be due to problems in the neck.


              • #8
                I would do the nerve blocks and see if any of those improve the lameness. While slight, a good lameness vet will be able to detect a difference if there is one.

                Also, do not dismiss the stifle bone spur. My horse had front feet x-rays done in September (really for shoeing purposes as we were xraying his hocks and stifles because he also has a slight toe drag and I figured what's a couple more views) and there was a hint of a bone spur on his RF navicular but it didn't overly concern my vet as he was still sound at this point - 2 weeks later he was very lame. By mid-October he was diagnosed with fractured navicular bones and significant navicular disease. I now wonder if we had done more navicular views when we saw that little bone spur, could I have caught it earlier before he went lame. I think my case is kind of the extreme and I wouldn't tell every owner with a horse with a bone spur somewhere that they need to go MRI that body part, but just saying I wouldn't dismiss the bone spur.
                "And I saw heaven opened, and behold a white horse..." ~Revelation 19:11


                • Original Poster

                  Thanks everyone for your thoughts and advice. Along with your posts and talking to friends at the barn, my plan is to:

                  Stop the previcox tonight. My vet apt will be late next week so it will have time to work out of her system and then I will have a few days to compare her being off previcox vs. being on and have more analysis to go with.

                  Im going to go ahead with the nerve blocks up to the stifle and see if she blocks out at the stifle to determine if its the bone spur causing her problems. At least that would provide some info about the spur. He says he palpated it and didnt get a response and since she was negative for the flex tests, thats why he wasnt positive its causing her symptoms but it certaintly could be. He thinks she could have torn her ligament at an early age and caused the spur. She didnt have much arthritis in her other joints, less than he was expecting for an 11 yr old so he doesnt think she was worked hard or much before this "maybe" injury happend and thats why she was sold in a fishy deal, aroung age 5 or 6 and have been in light work since. Anyway, this is all guessing so who really knows but at least Ill be able to find out if its related to the stifle. Im not sure Ill go higher than the stifle.

                  If its stifle, ill probably try Pentosan or legend (thanks Deltawave!) before injecting the joint OR keep her on previcox for awhile longer and get her out on the hills as much as possible. Im lucky that we have permission to ride on the neighbors driveway, which is a long steady incline, about .5 miles up. I have been getting her out there 2x a week but can increase it or do multiple trips instead of just one.

                  If its not stifle, ill probably do the exact same thing I JUST described above.....so hmmm....do I need the blocks or not? ARRGGG.

                  I should have mentioned that this vet is also a chiropractor but I do have access to another really good chiropractor who comes out who is very holistic. I could always use her for a second opinion.

                  Of course this will all be discussed with my vet. I dont think ill be doing the bone scan

                  I wonder if hind shoes would help.....



                  • #10
                    Most good chiros prefer to work with a vet's specific diagnosis with pictures. They know they cannot see inside and also know they could cause alot of harm manipulating and adjusting if there is an old fracture or other condition that could be aggravated instead of helped.

                    Get the blocks, bottom up. Denial is more then a river in Egypt as they say. Don't talk yourself out of what so many long time owners have advised.
                    When opportunity knocks it's wearing overalls and looks like work.

                    The horse world. Two people. Three opinions.


                    • #11
                      I have a horse who's always been a little hinky behind (truthfully, I have two of them). I haven't had the funds for diagnostics. My strategy has been to treat the whole horse with the theory that even if I found one problem, I'm fairly sure there's really more than one problem. I've taken the "systemic joint management plan" approach = adequan (Acetyl-D), oral supplements (SmartPak Senior Flex), and 24-hour turnout; MSM, flaxseed, good groceries, etc. Consistent work, as correctly as possible, at a level he/they tolerate. I would LOVE to know what's going on inside both of these guys, but really, I'm probably doing exactly what I'd do if I knew.

                      You mentioned shoeing. I have an amazing farrier who put hind shoes on my TB years ago and gave him a new lease on life. No shoes = no canter, hind shoes = two leads. 5-week shoeing schedule keeps his stifles (and me) happy.


                      • #12
                        Originally posted by ActNatural View Post
                        If its not stifle, ill probably do the exact same thing I JUST described above.....so hmmm....do I need the blocks or not? ARRGGG.
                        Perhaps discuss treatment options and variables a bit more with your vet prior to deciding... But if the treatment is going to be the same regardless of the results from nerve blocks, and your currently trying to be conservative with your finances (for good reason), I would be inclined to focus the finances on good treatments for now. Once your human family's medical needs are taken care of then you can spend some money on horse's diagnostics.


                        • Original Poster

                          Originally posted by Twisted River View Post
                          Perhaps discuss treatment options and variables a bit more with your vet prior to deciding...
                          Yeah, I will. He gave me a ton of information over the phone yesterday and then asked what I wanted to do, being nerve blocks, but said he would call me later this week to talk again after I had time to think and to schedule an apt.

                          Ill be sure to talk to him about hind shoes too. And her diet. She's on corta-flex HA and 15,000 MSM.

                          Ill keep you all posted


                          • #14
                            I agree with those that say the blocks will likely be helpful in pin pointing the issue. If you decide you can't afford the blocks a loading dose of Pentosan is going to be the most cost effective option. Legend is a good option too but it is more expensive than Pentosan for the 3 shot loading dose and unless you can do your own IV shots requires a vet visit. Just something to think about.

                            I think Findeight has a very good point about the Previcox. It is very risky to keep a horse in work while on a pain killer like Previcox for an undiagnosed issue. I know it is a popular choice for pain management for older arthritic horses but you could be masking pain for an issue unrelated to the bone spur and not even know it.
                            Even if the stifle DOES block I still think going to Previcox afterwards to manage pain is much riskier than using something like Pentosan or Adequan as they will actually help treat the issue rather than mask pain. NSAID's like Previcox can mask pain related to soft tissue or even a fracture of some kind and you would not even know it.
                            If you chose to not do the blocks for financial reasons Pentosan for a month is not going to cost much more than a month's worth of previcox. If you see improvement with the Pentosan you will have the peace of mind that is most likely helping the issue at hand even if your not sure what the issue is.


                            • Original Poster

                              That makes sense, LookinSouth. Since she isnt very lame and most of the time, sound and has been this way for a few years and only being a bit worse after moving to our new place, and not responding to the flex tests at all, he suggested previcox because he felt the risk for 2 weeks was low. But your right and it makes sense that keeping her on it a few months to just try to leg her up more isnt ideal. Ill ask about pentosan when i talk to him next. I have a long list of questions to go over!


                              • #16
                                I would try to leg her up gradually. As long as she is getting better rather than worse, I wouldn't do any diagnostics. After you pay your unexpected bills, I would save some money and then do the Legend or other joint med. If joint medication doesn't work, I would plan to do the nerve blocks and the bone scan.

                                A diagnostic workup can be expensive. I would initially focus on spending the money on your priority items right now. Of course, I would also ask your husband if he is sure he needs back surgery now. Maybe he is willing to leg himself up, see a physical therapist and chiropractor, take some human version of previcox, and let the horse get her workup now. The horse has probably been NQR for longer than your husband, so maybe he needs to wait for his turn!


                                • Original Poster

                                  Haha, my poor husband! He herniated a disc between l4 l5. Been going on for about a year with physical therapy, osteopathy, and three injections. He walks hunched over and bent sideways, poor guy and is on a lot of meds. The only reason he has had to wait for surgery is because of a three month wait for a consultation with the surgeon. Its his turn definitely :-)


                                  • #18
                                    Get nerve blocks and the possibly MRI. I wasted a lot of money on a bone scan that didn't even light up his severely damaged hoof structure...so odd.

                                    Nerve blocks told us some, MRI told us the full story. The money for the MRI was definitely worth it vs the bone scan.

                                    If she is just barely NQR, you may need to lunge her/ride her to make her a little worse so that you can see improvement with the nerve blocks.


                                    • #19
                                      Curious to know how she's doing now....and your hubby too. ;-)