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Discussion on Lame only downhill after shoeing

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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 4
Registered: 10-2003
Posted on Friday, Jan 16, 2004 - 1:40 am:   Edit PostPrint Post

Hi there everyone,

My 6 year old TWH came up lame on the right front, possibly after being shoed January 9 by a new (to the horse) but very reputable and experienced farrier. I first noticed the lameness the day after he was shod, while going downhill at a walk on asphalt during a very short (15 minute) outing. (The trails are too muddy to ride much right now.) However, it had been a couple weeks or so since I rode him downhill, so who knows exactly when it started.

Billy is in good condition, has ridden trails on an almost daily basis for an hour or so during the from mid summer up until winter hit really hard about a month and a half ago. Since then I have been doing some relatively mellow ground work with him (Clinton Anderson's Lungeing for Respect program, on video, which I really like), and occasionally I have ridden him on the asphalt roads around the boarding facility, but only for 20 minutes or less and only at a walk. He has been stalled otherwise, as it is too muddy even in the turnout area. While at a different ranch over the end of summer through mid-December, he developed a very superficial quarter crack on the right front, which both a vet and the new farrier at the current boarding facility felt was completely non-painful and likely due to the medial-laterally imbalanced trimming done by the last farrier. It was treated by "excising" the crack area but neither vet nor farrier felt a bar shoe or further trimming was needed. So far the crack seems to be resolving but it's too early to say for sure. It is still nonpainful to hoof testers or direct digital pressure.

On the day I noticed his lameness downhill, he had picked up some thick mud with stones in it in his soles on the short ride, including a small stone stuck between the inside heel of a front shoe and his heel, which I promptly picked out upon return to the ranch. It couldn't have been present more than a few minutes, but I can't remember which front foot it was in. We never went faster than a walk on this ride.

After picking his feet clean, I trotted Billy in the round pen and didn't see any lameness. Next day, I saddled him and rode him back up the nearby hill (no lameness) about a quarter mile. Upon riding back down, he appeared lame again, but as soon as he was on the flats, no lameness apparent. Trotted him in the round pen again (no rider): no lameness evident.

Gave him a day off, rode up the hill less than a tenth of a mile, no lameness evident on the flats or uphill, but definite lameness downhill. I didn't detect any heat or swelling.

Vet exam today: no heat, swelling, pain on palpation. Hoof testers negative (Billy was falling asleep). Mild lameness (versus moderate with rider on board) downhill only. Not worse with flexion of fetlock or carpus. I will say that the vet who checked him is pretty inexperienced (aren't we all at one time?) but seems to do a thorough job.

I know you can't diagnose what's going on via the internet but I am wondering if there are any tidbits of info you can throw my way. I promise I did read the lameness articles. Is it possible for the hoof-testers to miss pain present in the foot? The shoe was not removed, but the nail heads were tapped lightly and negative for pain. I don't think we looked closely at the inside edge of the shoe for contact with the sole. I will do so. I'd be surprised since the farrier is supposedly excellent (takes care of all the many competitive horses at the stable). Any other thoughts?

I scheduled a different vet who was highly recommended for an exam but she's gone until next Friday. I'm bumming meanwhile and worried.

Thanks so much,
Cindy
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Imogen Bertin
Member
Username: Imogen

Post Number: 475
Registered: 4-2003
Posted on Friday, Jan 16, 2004 - 2:20 am:   Edit PostPrint Post

Cindy

This may be completely irrelevant to your case but the only time I had a similar experience it turned out to be a hoof abscess - as these develop and can travel in the hoof it is possible for them to be missed at early stages even with hoof testers. My poor mare was refusing to jump down which was utterly unlike her - because it was causing her great pain which I didn't realise until the abscess developed and the farrier was able to find it and drain it. The good thing about drops is that they are relatively easy to fix...

All the best

Imogen
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 9767
Registered: 1-1997
Posted on Friday, Jan 16, 2004 - 6:26 am:   Edit PostPrint Post

Hello Cindy,
As traveling downhill throws extra stress on the whole front leg it can exacerbate lamenss from just about any cause so a diagnosis will have to wait localization, just is case yo missed it the article that applies to your problem is Equine Diseases Lameness The Diagnosis of Lameness in the Horse.

Yes hoof testors can miss pain in the sole, particularly if the pain is mild like yours and the shoes are not pulled.
DrO
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Christos Axis
Member
Username: Christos

Post Number: 133
Registered: 11-2003
Posted on Friday, Jan 16, 2004 - 9:10 am:   Edit PostPrint Post

Cynthia,
If I understand your description, the lameness could be there a week before the farrier arrived. In that case, you only noticed the day after shoeing, because that's the day you went downhill, the shoeing being irrelevant.
Was this the first time he was trimmed correctly after a long imbalanced period? If so, I would allow a few days to adjust.
Just in case, I'd tap the nails once more after a couple of days. It may take some time for a close nail to give you a reading.
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 5
Registered: 10-2003
Posted on Friday, Jan 16, 2004 - 11:54 pm:   Edit PostPrint Post

Thank you all so much for your useful information. Very helpful. I am resting Billy until the second vet rechecks in a week and I'll address testing his foot with the shoe pulled at that time. Meanwhile I will check again for sensitivity associated with nails. I think I'll buy my own pair of hoof testers and learn how to use them! Christos, good point about the long imbalance period.

I'll keep everyone posted with what happens.

Take it easy!
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Christine Sizemore
Member
Username: Gingin

Post Number: 6
Registered: 11-2003
Posted on Saturday, Jan 17, 2004 - 6:07 pm:   Edit PostPrint Post

Hello Cynthia,
I have been thinking about your problem all morninig and would like to ask you a few extra questions....when you say "lame" or "mild lameness" what does that actually entail?? Uneven gait, reluctance to move, pacey-ness??? You also said that without rider on board and on the flat, no sign of lameness at all...have to tried taking your horse on the leadline up and down hills to see what happens? Also, do you happen to have a bareback pad available???
The reason why I am asking is that I experienced a very similar thing with my mare a while back...you also could have called her behaviour "mild lameness" when we were doing a certain thing. What I figured out accidentially is that when I rode her bareback with my bareback pad on (and a nice "cushy pad" below not to cause discomfort from sitting on her bareback)...NO lameness! Also, when another person was riding her doing the same things that initially caused her apparent mild lamenes...guess what...NOTHING either, no lameness!
What I deduced from that is that somehow her saddle and my riding caused her discomfort and she reacted by constantly shifting her gait. Horses are very good at trying to adjust their gait so that the rider/saddle become comfortable for them. What must have happened is that I must have shifted my weight in the saddle in way that made the whole thing uncomfortable for her and she adjusted with what definitely looked like lameness, but only under certain conditions. Now, I have learned that what seemed to me to be a well fitting saddle actually does not fit so well (or better put, the saddle may fit but she hates how it feels on her back with me in it), that she hates having her shoulders restricted (she is a TWH/QH cross and gaites very well when she wants to!!!) and that she will "tell" me by hobbling or uneven gait or reluctance to move or back up (the backing thing is now one of the best indications I have with her when something is not right....she WON'T back!) ...she now did this with 2 different saddles but is perfect when ridden with a barback pad only...I just ordered a treeless saddle and hope that her discomfort will be over from now on....
If you have a chance to try riding her downhill without saddle, it might be worth a shot!!

Goode luck! Christine
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 9777
Registered: 1-1997
Posted on Sunday, Jan 18, 2004 - 10:14 am:   Edit PostPrint Post

Christine's idea has merit.
DrO
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 6
Registered: 10-2003
Posted on Sunday, Jan 18, 2004 - 10:17 pm:   Edit PostPrint Post

Hi All,

Christine, I posted a reply to your post last night but I must not have done something right because it never showed up, obviously. So here goes again!

The lameness occurs with or without a rider on board, although it is less noticeable without a rider. It is definitely still there with no rider however. The vet and I walked Billy downhill with the lead rope and there it was. Bummer.

As far as a description of the lameness, it is a head drop during placement of the left front leg, and he appears to be "klunking" the left front down heavily as he gets off the right front. He spends a shorter time weightbearing on the right front. Normally he has an extremely long stride both front and hind, and at a slow walk downhill, even a mild downward head bob and shortened stride are easily seen. It appears to be a classic front leg lameness, nothing unusual about it to speak of.

Today I free-lunged him in the round pen just long enough at a trot in both directions to see how he is doing (after hand-walking him on the flats, both soft and hard surfaces, with nothing abnormal noted). I could not see anything other than the beautiful extended trot he normally has when not under saddle and left to his own devices! And no pain on nail tapping once again. I didn't have the guts or the heart to walk him downhill though!

Thanks again to all.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 9781
Registered: 1-1997
Posted on Monday, Jan 19, 2004 - 6:38 am:   Edit PostPrint Post

You will need to localize this on the hill if further diagnostics are warranted.
DrO
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 7
Registered: 10-2003
Posted on Monday, Jan 19, 2004 - 11:51 am:   Edit PostPrint Post

I agree DrO. I'll keep everyone posted as to what happens this Friday with the second vet exam. Thanks again for the rapid replies and your wonderful website.

Cindy
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 8
Registered: 10-2003
Posted on Friday, Jan 23, 2004 - 11:34 pm:   Edit PostPrint Post

Hi everyone,

The second vet examined Billy today and determined that he has a neurologic disease. We are devastated. She pointed out numerous signs, all currently mild but unmistakeable nonetheless. We are scheduled to be seen on February 9, the first available appointment, at University of California at Davis's teaching hospital for a workup. DrO, I am so worried at this point that if he has EPM, we are wasting valuable time in starting his workup and possible treatment if we wait that long. Should I try to get him in somewhere sooner? I read your article about EPM as well as other articles and it seems that the sooner treatment is started, the better. What do you think? (I'm not assuming he has EPM, but in case he does...)

Thanks,
Cindy
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 9832
Registered: 1-1997
Posted on Saturday, Jan 24, 2004 - 9:20 am:   Edit PostPrint Post

The question for your veterinarian should be, "is there any reason to believe it is not EPM". If the answer is no, I would recommend starting treatment as you wait for the blood titers for EPM to come back. See the article for interpreation of this test and why I rarely do CSF taps anymore and the treatment recommendations.
DrO
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 9
Registered: 10-2003
Posted on Saturday, Jan 24, 2004 - 11:18 am:   Edit PostPrint Post

Thank you sooooo much DrO. Makes total sense. I'd go crazy waiting and wasting precious time. I'll keep everyone posted.

Cindy
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 10
Registered: 10-2003
Posted on Saturday, Jan 24, 2004 - 11:30 am:   Edit PostPrint Post

Thank you sooooo much DrO. Makes total sense. I'd go crazy waiting and wasting precious time. I'll keep everyone posted.

Cindy
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 11
Registered: 10-2003
Posted on Saturday, Jan 24, 2004 - 1:33 pm:   Edit PostPrint Post

Sorry for the double post.

I contacted the examining vet. She feels that Billy is more likely to have wobblers, based on my statements that he has, since I've owned him the past 6 months, had a "loosey-goosey" type gait, as she calls it, and has been lazy picking up his feet, and has circumducted his right hind leg at a walk. She feels that his exam, along with my statements, leads her to believe he has had neuro deficits for months. I told her I don't trust my own evaluation of his gait in the past, other than presence or absence of obvious lameness, and that he was declared sound on a prepurchase exam on 7/14/03 by an experienced vet. I am a new horse owner, and although I am a small animal vet, evaluating horse gaits, especially a gaited horse's, is a different ball game, and being emotionally attached adds bias. I do agree that he is neurologic based on watching her exam and how he is mildly ataxic and paretic with tight circles, tail pulls, backing; interterferes intermittently during the latter maneuvers; and has what she thinks is forelimb hypermetria downhill.

She agreed to get a blood test next week, but didn't think EPM was high enough on the differential to warrant starting drugs.

My question to her was how wobblers could take so long to show up, as Billy is over 6 years old, and she said it can indeed show up this late. Have you seen cases undiagnosed until this age DrO?

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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 9837
Registered: 1-1997
Posted on Sunday, Jan 25, 2004 - 9:39 am:   Edit PostPrint Post

I have not, but I have seen reports of as late as 9 yr so it is possible. The main clinical differentiation is that EPM is unilateral to multifocal: if it effects both sides it usually is effecting different areas. Wobblers effects both sides the same but not always to the same degree.
DrO
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 12
Registered: 10-2003
Posted on Tuesday, Jan 27, 2004 - 11:18 pm:   Edit PostPrint Post

We're awaiting the results of a western blot test for EPM. Interestingly, I spoke with a resident at UC Davis about Billy. She told me that UC Davis is working on an IFA test for EPM which so far seems to be more accurate than any blood test so far. They are keeping their fingers crossed that it will definitely prove to be superior.

They also put any and all neurologic cases on LOTS of vitamin E, regardless of the suspected cause. Up to 8000 I.U. a day! They feel the antioxidant activity will potentially benefit any type of neurological case, even if it's not Equine Degenerative Myelopathy.



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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 13
Registered: 10-2003
Posted on Saturday, Feb 21, 2004 - 12:24 am:   Edit PostPrint Post

Hi All, wanted to report back on what happened with Billy at UCDavis, CA. He was graded a "2" out of "4" on his neuro exam; "0" being a normal horse and "4" being a horse who is down and can't get up. No pain appreciated anywhere, and he is very willing to flex his neck in either direction. His entire EPM panel, including blood and CSF, came back negative. His cerebrospinal fluid, obtained under anesthesia, was completely normal.

Cervical radiographs showed some mild arthritic changes involving the facets at C6-C7. At C3-C4, the ratio of the width of the spinal canal versus the (?) height of the vertebrae fell just within the range in which he could possibly show some stenosis on a myelogram, but otherwise all was normal.

The number one rule-out is Wobblers.

We decided, for a number of reasons, not to pursue a myelogram at this time, but rather opted for stall rest, hand-walking once or twice a day, high doses of Vitamin E (8000 I.U. daily) and Bute. Oh, and Time.

We are very bummed but happy that Billy is not in any apparent pain, and seems quite content despite his mild disabilities. I check him everyday as far as how he does with tight circles, tail pulls, etc. His signs don't seem to be progressing at least not at a rate that I can appreciate.

Keeping our fingers crossed.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 9986
Registered: 1-1997
Posted on Saturday, Feb 21, 2004 - 8:59 am:   Edit PostPrint Post

I am sorry to hear that Cynthia but I know that it is almost as bad when you have more questions than facts: keep us appraised the lack of distinct lesions might suggest a slightly better prognosis than a readily apparent narrowing.
DrO
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Christine Sizemore
Member
Username: Gingin

Post Number: 20
Registered: 11-2003
Posted on Tuesday, Feb 24, 2004 - 8:35 pm:   Edit PostPrint Post

Hello Cynthia!
Thanks much for the update! I was hoping you'd write back to let us know how Billy is doing. Please keep us posted!!!!

Christine
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Cynthia A. Nielsen
Member
Username: Wolfydoc

Post Number: 14
Registered: 10-2003
Posted on Tuesday, Feb 24, 2004 - 9:32 pm:   Edit PostPrint Post

No problem Christine. I just hope this experience has provided some valuable and practical info for all our readers (I wonder if the entire post should be moved to the neuro section?). It sure has been a learning event for me. Never ignore any abnormality in your horse's gait; learn how to recognize some basic clinical signs of neurological disease in the horse; realize that horses can compensate really well for such problems and therefore they may go unnoticed by the owner; etc., etc.

I'll let everyone know how things are going.

Thanks so much for the support.
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