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

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    Original Poster

    #61
    My horse is always more sore to the touch in the lumbo-sacral area although the more visible pathology is t-spine and c-spine. It's still early for me to draw a definitive conclusion on the SI injections, but so far, they are really helping him. It's been 2 weeks since injections, and I won't really know for sure the full results until weeks 4-6 most likely.

    He has been carrying himself in a compensatory way for months now, so it's going to take some slow reconditioning to see if we can maintain forward progress. I just couldn't get him to go forward enough to try to do some of that conditioning without the extra pain relief from injections. And we had to figure out where the real source of the pain was, since he was straining so many areas. I'm hoping we have found it.

    Comment

      Original Poster

      #62
      A month more has gone by, and horse has not bucked once under saddle at the canter since injecting the SI. Less hoppy feeling altogether, and no hopping through lead changes.

      I am still having trouble getting the canter under saddle, and transitions both directions are still guarded. Per vet's instructions, we've been doing a lot of trot poles, including raised ones. He will now trot happily over 6" cavaletti rather than jump it 3' in the air. 12" cavaletti also getting boring, and I need to remind him to jump it. I've done minimal cantering over cavaletti--tried one line of trot in canter out. The canter is still kind of a hot mess, but this went ok until he clobbered one jump and then commenced leaping 4' in the air. But this is to be expected for him

      His back soreness is improved but not gone. I had to put all bats/whips away because he got too sour to them. Which is what I'd used to get the canter departs. So, the canter started to go away again. Vet put him on a double dose of Robaxin (15g 2x a day), and this made him SO LAZY that it was even worse. Trying to warm him up at the canter on the longe kind of helped, but he got tired quickly. So, we took him off of that in case it was having a sedating effect and are trying Prozac again to see if we can break his mental anxiety without making him sleepy. He's also back in Equipak now that the weather is dry again and flies are out.

      Prozac overall is helping his behavior. But some days, he's still a teenager. It takes a LOT of effort on my part to get the canter set up and convince him it's ok to strike off. Took me an hour yesterday. But then after he did a few laps, I let him quit. Because he'd gotten stuck trying to get the canter, I then asked him to pick up a trot on a long rein. And he struck right off into canter instead. So he CAN do it just fine. I think he still doesn't believe he can. Vet thinks he would really benefit from doing more cantering, and that the canter should feel better than the trot. I just cant get him into it. I can hardly get a forward trot. I don't know where this lazy horse came from.

      Some days, I use one of the taller cavaletti to get the canter. This is what I did today, because I didn't have time to work through the issue otherwise or want to pick the fight. He was in a really good mood from the moment I brought him in, and I wanted to maintain that! Eventually, I was able to keep the canter around the turn and kick him into a hand gallop. He seemed to like this, as his ears went up and he felt more loose. Did that once each way and got off.

      I have a strong leg but damn, this horse has turned into the mega thighmaster!

      I've considered ways to change his diet for more energy, but the vet thinks he could lose a couple lbs off his belly, and she recommended feeding him more like a PSSM horse just in case, which I think I mostly do anyway (except for the positive reinforcement peppermints that are helping the behavior). Although I have cut down some on his oil due to not wanting him to get fat. Not sure what else to do?

      At least he is back to really liking jumping again and not getting too anxious, which is a good sign. He gets so bored just going round in circles.

      I'm going to take him off property this week to get more life experience. Hang out at a show again. I'm not going to worry about cantering there if it's going to be an issue. He can just walk around if he wants...there are some hills we can walk on too. Start again next week.

      Comment


        #63
        Thank you for updating! I'm glad to hear that the SI injections seemed to have helped.

        I'm curious about the Prozac. Is it strictly for anxiety? What is the dosage for a horse?

        Comment

          Original Poster

          #64
          It is for anxiety as well as related compulsive behaviors. Some people use it for weaving and other compulsive vices. I can't say it helped him handle his field trip last week, though. It was his 4th time at that venue, and he had some calm moments but the crazy moments were very crazy! Something would set him off, and he couldn't bring himself back down, and I did all I could to keep from making a scene. The footing in the longe area also wasn't working for us, so overall not a good time. It was by far his worst behavior at this place. And I have picked up some coaching clients and did not have the time to devote to fixing my horse's issues properly.

          He's doing pretty well to ride at home, so I guess I'll focus on that for now. His left lead canter departs are pretty good. Right still needs some work. But hey, at least we are cantering!

          Anyway, the dose is a compounded injection at 5cc, split into 2 shots of 2.5cc in the pectoral muscles. This still caused a big muscle knot at one of the sites this time that required some sweat and a cold hose, so if I continue it for another month or two, I will probably go back to oral. The oral liquid dose for a horse his size is 1.5cc/day for oral suspension of 100mg/cc. There are pill and capsules available, but I've only had experience with those for small animals. The liquid is an oil suspension and really gross, but this horse has kind of a hard time with the injection.

          Comment

            Original Poster

            #65
            Since my last post, the bucking at the canter has returned, although at least he is still willing to offer the canter most days. I think he strained something doing his insane airs above the ground off property. Ugh! I've had the chiro out, and I'm doing more walk work, trying to get forward walk, and lengthening and shortening at trot and some light lateral work. He's doing quite well at that. But after we trot a bit, he starts getting anxious thinking canter is coming. I'm taking it very slow until whatever he tweaked calms down---at least, I hope it calms down.

            Chiro vet thinks his back muscle tightness has improved a lot from where it was, but they are still too tight in the lower thoracic to lumbar area. She thinks I ought to do the EquiSeq hair test for at least 4 of the 5 PSSM variants they apparently look for. It sounds better than a muscle biopsy, but I have to do some more research on it. Overall, she thinks his diet is great if he does have something like that going on, except that I would have to get the hay tested, and if it's too high NSC, figure out how to soak/steam etc. because buying all of my own hay is going to be as impractical as buying my own horse property upon which to feed my own hay. She did think that repeating the SI injections after 3 months as recommended by the clinic sounded like a good idea, and she's seen early repeat injections for that area last a long time.

            Comment


              #66
              Originally posted by IPEsq View Post
              Since my last post, the bucking at the canter has returned, although at least he is still willing to offer the canter most days. I think he strained something doing his insane airs above the ground off property. Ugh! I've had the chiro out, and I'm doing more walk work, trying to get forward walk, and lengthening and shortening at trot and some light lateral work. He's doing quite well at that. But after we trot a bit, he starts getting anxious thinking canter is coming. I'm taking it very slow until whatever he tweaked calms down---at least, I hope it calms down.

              Chiro vet thinks his back muscle tightness has improved a lot from where it was, but they are still too tight in the lower thoracic to lumbar area. She thinks I ought to do the EquiSeq hair test for at least 4 of the 5 PSSM variants they apparently look for. It sounds better than a muscle biopsy, but I have to do some more research on it. Overall, she thinks his diet is great if he does have something like that going on, except that I would have to get the hay tested, and if it's too high NSC, figure out how to soak/steam etc. because buying all of my own hay is going to be as impractical as buying my own horse property upon which to feed my own hay. She did think that repeating the SI injections after 3 months as recommended by the clinic sounded like a good idea, and she's seen early repeat injections for that area last a long time.
              The muscle biopsy really isn't that big of a deal and can turn up other muscle issues that aren't pssm related.

              Low nsc, high oil is the prescribed diet for pssm1. You can test for that with animal genetics, it is a hair sample. $40 fee.

              Pssm2 horses may be also be nsc sensitive for other reasons, but pssm2 is not a glycogen storage issue so diet nsc generally does not have to be as low. Dr. Valberg, out of Michigan state, has found some improvements with amino acid supplementation for pssm2 horses. There is a recently published paper on myofibrillar myopathy (MFM) by valbergs group that you may find interesting. MFM is a pssm2 subset found in warmbloods and some of the symptoms are consistent with your horses back issues.

              equiseqs pssm2 tests are not cheap and they haven't published or shared any validation of their method so it is buyer beware at this point.

              Comment

                Original Poster

                #67
                Interesting. The vet thought that MFM was a TB issue, most commonly in mares? She did warn me that it's not a verified test, but her opinion was favorable. She thought it would be worth testing for at least 1-4 if not that plus MFM. Horse has been on amino acid supplementation forever, so while I suppose I could up that, I'm not really sure I want to have the information....how would I change his management any more for the better as far as these things are concerned?

                Comment


                  #68
                  Originally posted by IPEsq View Post
                  Interesting. The vet thought that MFM was a TB issue, most commonly in mares? She did warn me that it's not a verified test, but her opinion was favorable. She thought it would be worth testing for at least 1-4 if not that plus MFM. Horse has been on amino acid supplementation forever, so while I suppose I could up that, I'm not really sure I want to have the information....how would I change his management any more for the better as far as these things are concerned?
                  RER has higher incidence in TB mares, although that doesn't discount horses of other breeds and especially those with TB blood from having RER. MFM is a recent diagnosis within the group of horses previously diagnosed as PSSM2 by muscle biopsy and they have published findings in Warmbloods and Arabs thus far. Essentially, any horse who had muscle histology abnormalities and symptoms consistent with muscle pain/tying up that did not have a glycogen storage issue (draft and stock breeds primarily) were categorized as PSSM2. Newer research is separating out the PSSM2 group.

                  Valberg's lab website is updated frequently and provides info on the various muscle myopathies and management.
                  https://cvm.msu.edu/research/faculty...orage-myopathy

                  Citation for the paper I mentioned above
                  Valberg SJ, Nicholson AM, Lewis SS, Reardon RA, C.J. Finno. Clinical and histopathological features of myofibrillar myopathy in Warmblood horses. Equine Veterinary Journal (in press)

                  Info from Valbergs lab on diet and exercise recommendations.

                  Regular daily exercise is extremely important for managing horses with MFM.

                  Diet: Exercise seems to be much more important than diet for MFM horses. The details of the best diet for MFM remain to be worked out. The principles we are working from are designed to increase turnover of structural proteins in the muscle and build muscle strength. At present we recommend a diet with low to moderate starch and sugar content, fat added if needed for weight and the addition of a whey-based protein supplement to add muscle bulk.

                  What are you using for an amino acid supplement? Amino acid supplementation tends to focus on lysine, threonine and methionine but I suspect taking a look at dietary branched-chain AA would be useful for horses with these issues.

                  Equiseq's naming system for their variants can be confusing, especially since we don't know what they are but I believe they were at least saying at one point that p3 is related to MFM.

                  Comment

                    Original Poster

                    #69
                    He currently gets Nutramino added. He's also on 3 flakes of 3rd cutting alfalfa throughout the day. He does not get a BCAA supplement except for what's in the regular Platinum Performance Equine, which he's on because I cut back on his concentrates below the recommended daily amount.

                    Comment


                      #70
                      Amino acid research in horses is sparse and there isn't any data on required BCAA for healthy horses, never mind those with muscle myopathies. There are other supplements that will provide greater BCAA, but whether that is really necessary ????

                      I would hold off on throwing a supplement at it until you have done the testing. Even if he does have a muscle myopathy it doesn't sound like a supplement will be a magic bullet but rather a portion of a total management system, so no point in throwing money at it for now.

                      However, how far below the recommended feeding rate of the concentrate are you feeding? You may want to take a look to make sure you are meeting protein reqs. Depending on how far below the recommended feeding rate you are providing, even with the amino acid supp protein in the diet may be deficient or marginal. Although alfalfa is higher in protein than other forages, small intestinal digestibility is still low so it won't provide as much dietary protein as you may think.

                      Comment

                        Original Poster

                        #71
                        He's on approx 3lbs TC Senior versus 6lbs. He's been on this diet approx 6 months? Previously, for the year and a half prior, he was on a RB. He was put on the RB when he was laid up and kept on it through rehab. Before that, when he was in full work, he was on 6lbs TC Senior plus Tri Amino and sometimes a top dress of TC 30 because he was super hard to put weight on and get fit. Alfalfa has stayed roughly the same. I didn't like his condition and coat on the RB, and he had a lot of belly issues, so that's why I made the last change over the winter....it started with an elimination diet. He's on a little bit of beet pulp to help mix his supps in, but I found his gut doesn't tolerate a lot of beet pulp--too much gas after a certain point. Because he is holding weight better now as he grows up and the vets recommended flax oil for his belly, I didn't need a full ration of TC Senior to keep weight on, but I kept with that feed because as far as digestion and appearance goes, he is doing well.

                        On his current diet, his coat and skin condition have improved as well as his feet. He's growing a lot of strong hoof right now for the first time in forever. And most days, we are not having the belly/hind gut upset he is prone to. He's not building muscle fast, but he's putting on a neck, and the vets are ok with his progress. The main issue is the chronic, excessive tightness of the epaxial muscles and the associated gait and behavioral problems linked to that.

                        Comment

                          Original Poster

                          #72
                          This is what he looks like now....hopefully this picture won't show up super tiny.

                          Comment


                            #73
                            Some rough math

                            600 kg horse in moderate exercise requires 921 g crude protein, dry matter basis
                            TC Sr @ 3 lb as-fed per day = 171 g CP, dm
                            Alfalfa @ 2% BW = 26 lb alfalfa per day as-fed (15% CP) = 1592 g CP, dm
                            BUT if we take into account small intestinal digestibility of only 28% alfalfa is only providing 445 g CP, dm
                            17 g AA from Nutramino = 17 g CP
                            Platinum Performance 132 g CP

                            Sum = 171 + 445 + 17 + 132 = 765 g CP

                            Requirement - diet = 156 g/d CP deficit

                            I remember your gut saga, I believe I suggested dropping the beep pulp . Interesting that he does okay on TC Sr since it is beet pulp based but likely relative to total amounts you were feeding before vs now. I would guess that coat and skin are improved because of the higher fat in TC Sr, unless you were feeding a fat supplement on top of the RB.

                            The example above may not exactly represent your horses requirement and intake but if it is in the ballpark I would think about adding a small amount of ration balancer on top of the TC Sr.


                            Comment

                              Original Poster

                              #74
                              Oh, he doesn't get 26lbs alfalfa...more like 12lbs I'd guess on average given variance in flakes. I don't know the analysis of his current grass hay, of which he eats anywhere between 5 and 9 flakes a day, which tend to be more in the 2-3lb weight range per flake. The wide variation depends on his appetite any given day (since he is fed free choice), which can fluctuate greatly with him these days. It's still down overall from his previous free choice consumption. BTW, even though the picture shows him on grass, he doesn't eat much fresh grass at all, and unless we get unseasonable amounts of rain, it's unlikely he will eat much the rest of the season. Now we're in the everything is turning brown and dying phase.

                              It is interesting about the beet pulp, because he has always seemed to tolerate TC Senior well. He may also be a bit picky as to the specific beet pulp brand and formulation. He doesn't find all of them palatable, either. When he was on the RB, he was getting the powdered Cocosoya for fat. I quit using Smartpaks, so that's the main reason I dropped that. And then with his hind gut issues, I wanted to try him on a better quality fat. So, he gets about 1/4cup flax oil now (at one point was up to 1/2 cup), and the PP and HT supps are also flaxseed based. I'm finding it's better for his condition and itchies to get him the calories from these sources vs more grain.

                              I don't know if I want to add a soy based RB back at all. One vet suggested just adding bulk Lysine, but she's a big fan of a large amount of Lysine for horses like him.

                              Comment


                                #75
                                I didn't really figure he was eating 2% of his body weight in alfalfa, but figured it was best to run the example on the high end of possible intake which still generates a CP deficit.

                                Just out of curiosity, how much straight beet pulp were you feeding before?

                                I understand the hesistance to add soy back but did you make the change from beet pulp + ration balancer to TC Sr at the same time or did you eliminate them separately? It would probably be easier to use a ration balancer if possible.

                                Buckets of lysine really won't be useful, excess will just get catabolized for energy instead of being used for muscle, while it is the most the most limiting AA horses still need a complete range of AA. I would probably look into a whey based supplement instead of straight lysine.

                                Comment

                                  Original Poster

                                  #76
                                  Hmm.. I think I have more details of how I did the elimination diet on one of my other threads because there was also some supplement removal and probiotic/prebiotic additions in stages, but I basically cut the RB first, to which there was some improvement but not a lot, then added TC Sr, slowly adding it about 1lb at first then 2lb, but kept the beet pulp at the advice of my vet to do so. Wound up cutting beet pulp in half after that, and after a couple weeks on that ratio, he showed improvement, so I kept him there and added more TC Sr bringing us up to about 3lbs, fed spread out in 3 feedings of approx 1lb. The third feeding was added because I was frequently having to medicate him in the evenings myself and so got in the habit of giving him a snack at that time in case I needed to add meds. No straight beet pulp is added to the third feeding because I just soak the TC if necessary. Since that time, there has been a couple instances where the guys have started giving him heaping scoops of beet pulp again, some of his gassy symptoms returned, and I had to remind them to feed less. But otherwise, he's doing pretty well for him in the digestion department.

                                  Comment


                                    #77
                                    IPEsq I saw this article posted on the sport horse breeding forum and it made me think of all the struggles you've had with your horse. Very scary to think about how many horses could be affected by this issue.
                                    Everything the horse owner and equine professional needs to know about the C6-C7 skeletal malformation in TBs and TB-derived breeds.

                                    Comment

                                      Original Poster

                                      #78
                                      Thanks. I have seen that article. He's definitely due for his neck injections based on his way of going the past couple of weeks. He's also due for teeth, which will be taken care of this weekend. The plan is to inject SI again and neck on 9/15. Some of his SI symptoms are definitely back. I'm mostly doing walk/trot to try to build fitness and strengthen his back in the meantime. I'm also working on slowly unwinding the mental anticipatory problems. His digestion is good and his weight is good.

                                      Current trends show he has not been doing as well after a day or two off. Harder to warm up and more attitude. So, there's still lingering thoughts on PSSM type issues. But that could also be back. I mentioned in another thread that I put him on MagRestore, and the results have been great. Unfortunately for my wallet, he seems to need to stay on a higher dose (at least 3 scoops a day, versus the suggested maintenance dose of 1-2).

                                      This morning, he came up with swelling in his RH sort of mid-way on the cannon bone in the outside suspensory area. It's warm. No cuts or abrasions. Doesn't seem to bother him, though. I put him on the longe, and he's NQR, but it looks the same as his SI stuff. It's a bit short on the outside of the circle. But so is LH. Seems ok on the inside of the circle, and he was willing to trot and canter both ways without much attitude, which suggests he feels alright. A little hoppy looking left lead canter, which could again be the SI. I didn't do much. Just enough laps to get him forward enough to get a good look. Then I got on and walked for about 30 mins. Trotted a couple straight lines to see if I could feel anything funny. Seemed ok. Swelling went down a bit. Because I'm completely paranoid about this horse, I called the vet who said he can take a look as he drives by the farm this afternoon. I can ice this evening. Yesterday, he felt so good he even offered up a little bit of canter under saddle without a hissy fit. I'd think he just banged himself on something, but WHO KNOWS. Horses.

                                      Comment

                                        Original Poster

                                        #79
                                        Um... vet just texted me and said, it's just windpuffs and the same on both legs. I said, no, it was warm and swollen up higher, like mid way or so to the hock, one leg, one side of the leg. He says, not what I'm looking at right now. Am I mental? Did I make it up or did it just go away in 2 hours with some more movement back in turnout? Y'all probably ought to have me committed.

                                        This horse.

                                        Comment


                                          #80
                                          Whacked himself on something, got bitten by a bug? Who knows with horses!

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