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Is it possible to differentiate between Lyme and General Hock pain? Need Help!

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  • Is it possible to differentiate between Lyme and General Hock pain? Need Help!

    I would just like to start by saying the vet is coming out asap but I would like to pick my fellow cother's brains in the meantime....I am hoping someone has had experience in this area.

    Here's the story. I have been bouncing back and forth between ulcers, hocks and lyme the last few weeks. We made some changes to feed because horse was acting finicky about eating grain. Horse now gobbles down Senior grain (switched from pelleted), is getting smart gut, alfalfa cubes and aloe vera. There are no symptoms of ulcers at this point (finicky about grain was the only symptom before) other than crankiness undersaddle which is accompanied by obvious stiffness and unwillingness to use the hind end, especially in the corners. I am not leaning towards ulcers at this time. Horse if fat and shiny and eating/drinking very well, even when hauled on a trailer or off property.

    The last few months there has been mild stiffness in the hind end warming up, increased rooting and more difficulty getting the horse on the bit. In the past 3 weeks this has only gotten considerably worse. He is now VERY stiff and reluctant to go forward and cranky. He is better on straightaways than in the corners. Falling on the hind end during transitions. The Chiro said his hocks were sore and he may need hock injections. His hocks look a little ouchy when trotted on pavement etc...So there is clearly some ouchiness in the hind end.

    That said, horse also is slightly more spooky than usual and even on trail much more reluctant to go forward. He has been treated for lyme in the past (though symptoms were not like this) and carries a high titre. Some people I've talked to think it's lyme. We live in an area where lyme is very common.

    My question is if the vet pulls a titre/western blot and it's positive, how will I know that the symptoms are related to lyme and NOT hock soreness (i.e. needing hock injections). Is there anyway to know for sure?

    Does hock pain (related to needing injections) usually escalate that fast in a otherwise always sound older horse that has never needed injections in the past? The horse hasn't been jumping lately and is doing light easy work on the buckle w,t,c. It just seems he has deterioted very fast, in a matter of a month. I don't know much about hock sore horses because I've never owned one but to me it seems odd. I don't want to treat for lyme if that's not the case and vice versa.

    I am leaning towards lyme at this point but I am so confused it's ridiculous.

    Any experience other Cother's can offer in this area would be greatly appreciated!!!

  • #2
    You *won't* know the difference because, effectively, there *is* no difference.

    Lyme disease can cause arthritis symptoms because it causes arthritis--it can cause the joints to swell and create pain and stiffness. If the lyme disease goes untreated those arthritis changes and symptoms can become more or less permanent.

    Of course not all arthritis results from lyme disease, and the horse could have just plain arthritis.

    Either way it's definitely worth knowing whether the horse tests positively for lyme disease, and if it does, it's probably worth treating, particularly if you're in a lyme disease-prone area.

    Honestly, I would not sweat the decision to test (and treat if positive) at all. I've treated my horse twice for lyme disease; the first time she went undiagnosed for several months, and I did the whole lameness work-up thing, including a bone scan, before treating her with 90 days of doxy.

    The second time was 6 years later, and then her major symptom was dramatic weight loss and lethargy (as opposed to the lameness that had characterized the previous bout). She'd been de-wormed up the wazoo and all bloodwork normal except showed she had a high lyme titer. Another round of doxy and she was fine and has continued fine (knock wood) for two years.

    Good luck.
    "The formula 'Two and two make five' is not without its attractions." --Dostoevsky

    Comment


    • #3
      I thinK I might be more inclined to treat if I did not live in an endemic area. I've been told by several Vets that the vast majority of horses that get pasture time (in my own endemic area) will show some level of titer.

      I do a test once or twice a year and track the titer. This is not practicable if you have a lot of horses.

      Over the past six years, my horse's titers have fluctuated between 0 and 360 and back to 0 again. Anything over 200 and I retest in 6 weeks to monitor whether the titer is going up or down (if I ever had a high titer, I would retest more quickly). Fortunately, I've never had a horse show symptoms and I've never had an increasing titer on a second test. Yet.

      If I had a horse that was symptomatic (elevated temp/shifting lameness,etc.) and a high titer...I would most likely treat. I also might consider putting him some place where he would no longer be exposed to ticks. Kind of difficult if you want to do anything like trail riding.

      There is still so much debate on how to treat, how long to treat, the resistance of horses, etc. that I am not confident that treatment is always indicated with a positive titer. Especially, when you're going to return them to same environment where they will again be exposed. I'm a little concerned with interfering with the body's natural immune response with such frequent treatment.

      To give you my opinion on your question....I don't think there's anyway you can be sure whether your horse's symptoms are from Lyme's, arthritis, or another injury. An active infection is often accompanied with a fever but you may have missed the fever phase. When my horse has a fever, he really shows it so if you recall your horse running a fever for no known reason, I'd be suspicious. I've also heard that the Lyme's symptom is described as a "shifting" lameness which I understand to mean that it's in one leg one day and a different leg another day.

      I've also found that Veterinarians often have different opinions on treatment. The testing laboratories define different titer levels as significant and equivacol. I've experienced the same veterinarian practice recommendation change from year to year. It's clear that there's quite a bit not known about this disease and how to treat/eradicate it. Hopefully that will change in the future.

      Comment


      • #4
        If you think it's lyme, I would hit it with at least 5 days of Oxytet then follow with a long course of doxy. There was a Cornell study done several years ago that showed this therapy had the best chance of eliminating the disease.

        It's highly possible that your horse has never been able to clear the infection and, in times of stress, it overwhelms his system again. I would certainly avoid any steroid use (oral or injection) if at all possible.

        What a nasty disease!

        Comment


        • #5
          I would get radiographs on the hocks now before I started treating anything else. They can clearly tell you what you are dealing with. If the hocks come up clean, I'd check the stifles. You can get a western blot for the Lyme in the meantime, but I'd really get the radiographs if it were me.

          Comment


          • #6
            If Lyme comes back negative, check for Anaplasma titer. The symptoms are very similar to Lyme, with hock pain being a major symptom.

            Comment


            • #7
              Diagnostic anesthesia of the tarsal joints can help determine whether they are the site of the lameness.
              "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

              ...just settin' on the Group W bench.

              Comment


              • #8
                I just went through this scenario - but no outward lameness. My horse just stopped jumping. Period. We were treating him for a crashed thyroid. And Lyme (with pasted doxy - 90 days worth). And he was still not right. Scoped him for ulcers - none of the usual symptoms, just a suspicion based on his demeanor. Grade 2 ulcers. Acupuncture points "lit up" for hock soreness - a byproduct of the Lyme disease??? - at the same time. SO, two months of Gastrogard (we had finished the 90 days of doxy by this point), AND hock injections. Result? After 8 months of trying to get it all right, I have my wonderful horse back. We start showing again next week on an easy schedule and plenty of u-guard. It was like going around in circles. I still couldn't tell you, other than the thyroid issue, what was connected to what and when. All I know is that we treated symptoms as they occurred, and my vets were really open to what we were experiencing with him on a daily basis. They were at a loss at one point as to what was going on, but what really helped us out was the acupuncture. Pretty much told the story and we went from there. Good luck. It is tough to puzzle it all out sometimes.

                Comment


                • #9
                  Originally posted by Ghazzu View Post
                  Diagnostic anesthesia of the tarsal joints can help determine whether they are the site of the lameness.
                  And if one were highly suspicious of current/active Lyme disease causing the lameness, one could at the time of injection collect a sample of synovial fluid to send for PCR testing to look for the presence of Borrelia, no?
                  The plural of anecdote is not data.
                  Eventing Yahoo In Training

                  Comment


                  • #10
                    I would also get hock Xrays in addition to the Lyme test. Hocks can cause so much pain and sourness. The Xrays should be definitive and tell you exactly what you are dealing with if it is hocks.

                    Comment

                    • Original Poster

                      #11
                      I talked to my vet and the plan is to 1) pull blood for WB/Titre and see where he is at 2) x-ray hocks and do a lameness eval 3) Treat for lyme and/or inject hocks as needed.

                      My concern all along has been that the WB/Elisa will show up positive and the issue will turn out to actually be the need for hock injections. We all know that lyme tests are not 100% definitive. I really don't want to put my guy through a course of doxy if it's not needed.

                      I will mention the hock fluid analysis for Borrelia to my vet, that may turn out to be helpful.

                      Also, I have heard that pain from lyme won't respond to bute. Is that true? If so, I could try buting him for a day or two and see if there is any progress. A gram of bute once a week helped tremendously with some general stiffness in the hind end this winter.... IME with lyme in another horse there was no response to bute whatsoever. I'm wondering if other people have had that experience.

                      Comment


                      • #12
                        Not that experience specifically, because my horse can't have bute due to ulcers. But the hock pain from the Anaplasma did not respond to Previcox (Equiox/fibrocoxib) at all. That's probably not relevant to your situation but thought I'd throw it out there.

                        Comment


                        • #13
                          Originally posted by Birch3280 View Post

                          The last few months there has been mild stiffness in the hind end warming up, increased rooting and more difficulty getting the horse on the bit. In the past 3 weeks this has only gotten considerably worse. He is now VERY stiff and reluctant to go forward and cranky. He is better on straightaways than in the corners. Falling on the hind end during transitions. The Chiro said his hocks were sore and he may need hock injections. His hocks look a little ouchy when trotted on pavement etc...So there is clearly some ouchiness in the hind end.

                          That said, horse also is slightly more spooky than usual and even on trail much more reluctant to go forward. He has been treated for lyme in the past (though symptoms were not like this) and carries a high titre. Some people I've talked to think it's lyme. We live in an area where lyme is very common.

                          My question is if the vet pulls a titre/western blot and it's positive, how will I know that the symptoms are related to lyme and NOT hock soreness (i.e. needing hock injections). Is there anyway to know for sure?

                          .

                          !!!

                          Spooky due lyme disease? Maybe I read that wrong? As the owner of a hock injected and lyme disease horse I can say when my horse had his bout with lyme he was lazy, never sore just plain out l a z y. His titre was the higest the vet had ever seen. He's been fine since - this was a few years ago.

                          Sounds to me like your horse is just hock sore. Him not wanting to work from behind and considerably getting more sore tells me this. Yes, I feel it just sneaks up on you. It did for me. Healthy, sound horse out of no where became slightly stiff and then just sore. Had his hocks done and he is a new horse.

                          The only way after the titre results to actually know if it is lyme or hocks is to do the round of probitics and Doxi. If you horse comes back ok after the meds then it was just lyme, if you still have issues in the back end I would research and think about hock injections. Keep in mind that a new set of hock Xrays should be done. Injecting the hocks is a risk and you do not want to disrupt the area if you don't have to.

                          I never buted when mine had lyme, all the other pills were enough. You should not ride while your horse is going through the cycle of pills (if it's lyme).

                          These horses always throw us for a trip that's their game

                          Comment


                          • #14
                            Good Luck! If you don't mind posting the results, I'd love to know what you find.

                            Comment

                            • Original Poster

                              #15
                              Originally posted by Ozone View Post
                              Spooky due lyme disease? Maybe I read that wrong?
                              Yes, very slightly more spooky/reactive to things like birds flying out of the bushes etc..but maybe it's just the fact that it's spring time and he is getting out more after a winter in the indoor *or was*.
                              This is the first time I have seen this symptom with my own horse but I have heard of other people noticing spookiness as a lyme symptom.

                              Thank you for your response. It was good to read that in your experience a horse can indeed decline quickly with hock soreness. Most people I talked to seemed to have milder symptoms than what I am experiencing with my guy.

                              I am hoping it is simply just hock soreness and injections will give me my horse back. He is definitely more stiff/lazy but I would call it stiff and reluctant to go forward more than downright lazy. He is not lazy at the walk. More stiff and reluctant at trot/canter. At the walk he seems fine.
                              The issue seems to be strictly in his hind end. I know lyme is often a shifting leg lameness and his issues definitely have not been shifting. In fact, it seems to be more the left hock than the right hock as well.

                              I will definitely get radiographs before we inject.

                              I am not suggesting that I ride if he indeed has lyme or during lyme treatment. Bloodwork won't be back until next week. I was suggesting that perhaps I should try bute for a day and try a light ride to see if any stiffness/hock pain in the hind end seems to resolve. I thought I had read somewhere that lyme related stiffness/pain often does not respond to Bute.

                              ETA: and I definitely will post my results when we figure this mess out

                              Comment


                              • #16
                                I believe (been a while) that the reason I did not bute with the lyme meds was because of lack of response from it. Again, it's been a while so...

                                Can you ask your vet and get back to us here on that too? Inquiring minds want to know!

                                When you bute him he seems a bit better back end wise? Humm. Well if that is the case and once we can clarify if bute is a no response to lyme then wa-laaa... betcha its his hocks. Felt it was his hocks from the beginning of the thread sounds too much like my horses story.

                                Horses are so very different symptom wise. My horse was laying out, passed out flat in his stall. Head under the door at times. I walked in one day and literally had to wake him up... and thought ok - get the vet out tomorrow Bam - lyme!

                                Curious to the outcome! Good Luck!!!

                                Comment


                                • #17
                                  Heightened reactivity *can* be a symptom of lyme disease, but so can lethargy. Each horse is different.
                                  "The formula 'Two and two make five' is not without its attractions." --Dostoevsky

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