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Update - new imaging - Diagnosing back pain from behavioral symptoms, or, kissing spine differential diagnoses

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    I really feel for you, IPEsq
    "Hope is a good thing, maybe the best of things, and no good thing ever dies."

    "It's supposed to be hard...the hard is what makes it great!" (Jimmy Dugan, "A League of Their Own")


      Ugh. I have so much empathy for you having been down the same path. You have been a lot more persistent and diligent than I was.

      As many here know, my horse was euthanized, not retired, when he was seven. He did have an obvious neurological deficit that, while low on the neuro scale, was causing his recurring lameness issues to occur in an annoying and repetitive combination of Groundhog Day (the movie) and Whack a Mole (the animal, not the chemistry counting unit).
      The Evil Chem Prof


        It's so hard...especially when you know there is something going on...but you just can't seem to find the exact thing to fix. Or there is no exact fix for the issue. For what it is worth, my gelding was 5 when his SI issues started. We tried to manage it for almost 2 7, I kicked him out to pasture for 14 months. His prognosis was to potentially be comfortable enough to maybe lightly hack. He is showing PSG...schooling I1 and I think we might even be able to think about GP as being a possibility. I tried everything...turning out was the last straw with my guy. I even considered euthanizing him about 3 months into turnout only...he was so miserable and uncomfortable, he would barely move in the field (he had been managed on all kinds of pain/nerve meds...I weaned him off every medication when we opted to do Dr Green. He was pretty miserable for a while, even with the slow wean-off). I decided to give him 6 months before I euthanized. By 5 months, he started rolling 6 he would trot a 8 months he started to play/buck. I second guessed myself more times than I can count through that entire period. But, I knew my guy was a deep down good boy and talented...and was worth the time and effort to try. It's a tough situation


          Original Poster

          I learned some things at the presentation on neck, back and pelvis tonight. Including scary things like apparently horses can tear holes in their supraspinous ligaments. And despite CSU and literature saying disc disease doesn't really affect horses clinically, apparently it does when the disc is totally gone.

          But moving on...I asked the dr if I could pick his brain about my horse since the talk was at the one practice that hasn't seen him (yet). Told him what was found, what we've done, how horse likes to keep trying to injure himself in other ways, and that he's still not right and I don't know what to do. Well, I must have a pretty good sob story because it ended with him saying, here, let me just give you a handful of mesotherapy needles. He also thinks I should test for Lyme.

          I did find out that we don't have to use steroids to potentially get a good result from mesotherapy. So, I may well try that before going back to more joint injections. There's also something called Ober technique injections which target different nerve roots, particularly around the scapula area and also puts some medicine near the joints but it's more of a widespread, blind injection, not trying to get into the joint capsule. He said my CSU sports med vet would know what that was.

          Very interesting.

          And for anyone curious, he hasn't tried Pro Stride in a neck yet but has for other joints. He said he was itching to try it but there is a slightly increased risk of a flare reaction, which would be really bad in a neck, so they haven't done it yet. They do use IRAP sometimes (so does CSU), and when asked if they have to do the series of 3 injections he said they didn't really know. Sometimes they also use Adequan IA. I remember there being a thread on that recently where a lot of people hadn't heard of that route of administration. Apparently it is a thing and works for some horses.


            Original Poster

            Chiro/acupuncture vet was out today. I was able to warm him up on the longe line a little bit before she arrived. He was back to behaving pretty well for that. Started out unsure and a little cranky, but once he started moving he was very willing to move and was very good about picking up a canter both directions. Took me a minute to get him to want to bend into the circle instead of counter-bend, but he only went around about 10 mins.

            Chiro vet said his behavior is exactly like a kissing spines horse. So we talked about the bone scan, recent X-rays, everything else we've done. He was really liking the bodywork today and seemed the most sore in the croup, which vet felt was likely compensatory. He only got upset/tried to leave when she did acupuncture near T-16 and was like that on both sides. This is one of the affected sites.

            She agreed to test for Lyme--apparently she has a couple of patients who have lived in northern CO their whole lives and tested positive, so Lyme is here. And she thought it would be a good idea to do the mesotherapy. She said either he'll act good for the 1-2 weeks and back to not good same cycle or it will be amazing and he'll get a good 6 months. She thought it was worth trying and also agreed that we didn't necessarily have to put steroids in the cocktail. She also thought it was worth considering gabapentin and even testing him for DSLD (ugh, wouldn't THAT be awful!)

            CSU is coming to the barn for another horse end of next week, and I'm going to have them look at my horse and maybe do the Lyme test etc. if they are in agreement since my regular vet is insisting horse can't possibly have Lyme etc. etc. He's great but sometimes gets a bit stubborn and/or myopic when he thinks he's found the problem and yet the horse doesn't get better.


              In re: lyme, get them to do the Cornell test.
              "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"


                Original Poster

                Originally posted by vxf111 View Post
                In re: lyme, get them to do the Cornell test.
                Yes, if we test for Lyme we will send to Cornell.


                  Original Poster



                    Have you ever considered or tried a magnesium supplement like MagRestore for the muscle tightness and other behavioral issues? What is your plan now?
                    "When I look back on my life, the times I have been stingy or unappreciative haunt me. I don't regret one instance of generosity." --PeteyPie


                      Original Poster

                      He's on 5g magnesium currently. I have tinkered with various brands in the past but never done a much higher dose, as I was worried about upsetting his GI.

                      Today, I followed the same initial plan as yesterday. I wanted to do 2 rides back to back to really gauge behavior. Warmed up on the longe, and he's a little lazy\. Going the right still looking good. Behavior is good at all gaits. Going to the left, he's a little less snarky, but boy does his RH movement look worse, and he's more braced in his body, although I am able to get some bigger circles out of him (he usually wants to cut in and give me the nasty face). As I encourage him to track up better/move out, he breaks into canter. He'd rather canter than trot with impulsion in that RH to the left. Canter looks fine.

                      I get on, no forward. Now he's really bracing in his back again . He's doing a bit more spinning on the forehand (rather than the hind end), and he is not bothering much to buck or kick out. He tries to trot once, goes like 4 steps then quits. I get off and longe again at the trot and try to get him stretching forward more.

                      I get back on and finally get some trot. He's back to the pattern of trotting a few steps then walking. It takes lighter aids (and mostly voice) to get him back into trot, so I allow him to walk (versus fight him), then quickly ask for trot again, until he can trot around without the breaks, both directions. To the left, I can feel he's carrying the haunches out, which disguises itself as leaning in with the left shoulder. I try to encourage him to be straighter, but I'm not really riding on any contact. He takes some breaths, stretches, and after a few minutes of this, I stop and get off. I did not try to canter. At this point, I spent so much time trying to get him to go under saddle the first attempt, that the few minutes of trot I did get is enough. After untacking, his back muscles are rocks, and he's tender in the lumbo-sacral muscles. Again.

                      I talk to the vet and tell her my observations so far, thinking that any good we were going to get out of the mesotherapy probably already happened, and the rest of the week may not go well. She advises to give 2g Bute tonight just to rule out any "I haven't worked this much in a long time" soreness and to give tomorrow off (day off already the plan) and see how he is on Wednesday.

                      We both thought the itchy neck reaction was very interesting. And that having one day of working with good ROM behind led to his RH looking worse than ever. But his behavior does not fit RH lameness, because trot is worse to left both under saddle and not, and canter worse to right under saddle. That, and he flexed neg in both legs.

                      So the question is still, is this neck or pelvis? My gut wants to say it's neck, but his behaviors kind of match SI issues too. I did just read a paper abstract on a study of SI pain 98% of study horses had positive response to SI area nerve block but only 43% had findings in that area on nuclear scintigraphy. So, yeah, maybe the bone scan wouldn't have found it if it's SI. But then THIS paper said that 99% of the study horses showed evidence on nuclear scintigraphy.

                      At least he's still pretty well behaved on the ground. Maybe by the time I touch base again with the vet on Wed/Thurs, we will have Lyme results.


                        Make sure when the ultrasound the SI they also look at it rectally. My guy had nothing on nuclear scan or xrays. It was only when they looked at the underside of the SI joint (rectally) did they find extensive remodeling and the nerve root injury. It was clearly the issue...though most of the imaging was not conclusive up until then.


                          Original Poster

                          Originally posted by Critter View Post
                          Make sure when the ultrasound the SI they also look at it rectally. My guy had nothing on nuclear scan or xrays. It was only when they looked at the underside of the SI joint (rectally) did they find extensive remodeling and the nerve root injury. It was clearly the issue...though most of the imaging was not conclusive up until then.
                          Yes they want him to go to the clinic for rectal ultrasound by a board certified radiologist. The vet said the problems in that area can be easy to miss.

                          A fellow boarder said his circumduction of RH on the outside of the circle screams SI issue based on her experience with her horse (who is 16 years old and they just found the problem this year). I'm kind of hoping he doesn't have to make another trip to the hospital. I am having trouble with trailer loading now (new thing this year), probably because every other trip is to the clinic. I'm almost inclined to inject as the diagnostic depending on how the rest of the week goes.


                            Original Poster

                            Followed vet's instructions, and horse was worse under saddle today. Completely refused to trot. Barely got any kind of decent walk. He was just hollow in his back, crooked, avoiding contact, very resentful of any go forward aids. On the longe, he was very willing, more so to the right than the left again. He had plenty of go so long as I wasn't sitting on his back. Still off on the RH tracking on a circle to the left (same lameness as Monday but that's a bit worse than he was for the vets last Friday). Still prefers to canter to the left than trot. Going right looks much better and he's happy at all gaits.

                            Tried getting off and on, putting him on the longe line several times, for short stints each time. He got more willing to go forward to the left as time went on and also appeared to move better, but every time I got on his back, his behavior was worse. The last time, I was on for less than a minute before just getting off, sending him out on the longe and getting a good lap of gallop and a few transitions which softened his facial expression back to less snarky.

                            I texted vet and asked her to look up some costs before we talk about how today went and what to do next. Hoping they will have Lyme results today as well.


                              Original Poster

                              Still working on a plan with the vet but wanted to update and say Cornell tests for Lyme were negative.


                                Original Poster

                                CSU came back out and watched him go on the longe again. Said they didn't see anything RH that day but LH now looked a bit wonky on the cranial part of the stride. He was more willing to make a big circle to the left as well. So, that was weird (and he hasn't repeated that exactly since), and they proceeded to do a trans-rectal ultrasound. The good news is they didn't find any OMG things going on. They observed that his L-S disc was "tilted" (meaning he was holding himself so crooked that it wasn't oriented the way it was supposed to be), but it looked healthy. And they noted some mild changes in the SI joints, with right side being worse than left.

                                Based on clinical presentation, they injected the SI joints both cranial and caudal sides, ultrasound guided.

                                He had a few days rest, then longed a couple days during which he was WILD. Then I started to ride at the end of last week. His walk under saddle is so much better. He's still slow but more forward and actually moves his back like a normal horse versus being rigid.

                                We still have a lot of behavioral issues with getting trot and canter under saddle, but each day we get a little bit better. There's less rearing, bucking, and kicking at the walls. He will still try to spin me into a far corner of the indoor, but I can get him out of it and immediately go forward. The trot is getting easier and easier to pick up even though we get stuck now and then. He is still the most reluctant to canter, so I have only really asked for it twice and done only a few laps at a time. The canter quality is a lot improved. It doesn't feel like he's hopping so much behind, and he quit crow hopping into the R to L change. Not that I've gone round and round at the canter yet, but this is the first time in a while he hasn't felt like we're constantly on the verge of bucking.

                                Baby steps. And lots and lots of naughty to undo. And also some weirdness (like, he's got to be sure he's pooped before he can think about cantering). It's still early yet, but I'm optimistic, and even if it's not the magic bullet for him, it does seem to be finally getting at some chronic issues.


                                  COTH just did an article (May 15, 2017) about nerve pain and how Dr. Chris Newton from Rood & Riddle in KY is treating it. I encourage you to read the article and possibly reach out to him or have your vet reach out to him.


                                    Original Poster

                                    Originally posted by SCI View Post
                                    COTH just did an article (May 15, 2017) about nerve pain and how Dr. Chris Newton from Rood & Riddle in KY is treating it. I encourage you to read the article and possibly reach out to him or have your vet reach out to him.
                                    Hmm a fellow boarder just told me she's going to bring me a COTH article to read...maybe that's it.


                                      Originally posted by IPEsq View Post
                                      Still working on a plan with the vet but wanted to update and say Cornell tests for Lyme were negative.
                                      My horse was diagnosed with SI pain last year and I did the injections. No result. Although the Cornell Lyme test came back negative, we retested. This time it was positive. My vet says sometimes he's seeing horses that have Lyme but don't show right away.
                                      Equine Ink - My soapbox for equestrian writings & reviews.
                                      EquestrianHow2 - Operating instructions for your horse.


                                        Original Poster

                                        Oh man, I am holding my breath here but we did a few canter poles yesterday! And once we cantered a bit, I had trouble getting him to stop breaking into a canter. He's still very apprehensive to start a ride and a bit naughty, but if I can get him bending at the ribs and not bracing in the shoulder, then once I move onto asking him to put his hind end straight and a little more under himself, he is raring to go! It's like he discovers, oh, huh, I can do this, this is ok!

                                        I've also been listening to his footfalls at the walk in the barn aisle. It used to go clop, clop, clop, CLUNK, with the loud one being left hind slamming forward. I walked through the aisle after the ride yesterday to go untack, and it was a nice soft clop, clop, clop, clop all the way around.


                                          I can identify with about 90% of this. Mine was diagnosed with KS and cervical arthritis. Injections in those areas did not help. That clop, clop, CLUNK is so familiar though. I think my vet pretty much wants me to give up because I have spent so much time and money on him and nothing seems to really help past a couple of weeks.
                                          Do you think the SI injections helped significantly? My horse's pain seems to be worst in the lumbar region and the KS is in the thoracic. So I have always questioned if there is more going on back there than just KS.