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Discussion on "Pee Lameness?" Could it Be?

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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 538
Registered: 3-2007
Posted on Monday, May 12, 2008 - 9:05 pm:   Edit PostPrint Post

About 45 minutes into a very good ride on Sunday my 13yo Holsteiner mare went off. For about 5 minutes she just seemed stiff and annoyed. Then she went markedly short behind (LH). Then she was LAME. I jumped off-- no heat no swelling and no noticeable pain response to anything. SHe was irritable about my checking her out, but that's her anyhow. I took off her tack and loaded her in the trailer, at which point she peed forever.

That evening she had again no detectable heat or swelling. Same this morning and she trotted up sound.

So-- transient weirdness? Any chance it was a "pee lameness?" I know I can't perform a collected canter if I'm in that condition.... Is there such thing?
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20652
Registered: 1-1997
Posted on Tuesday, May 13, 2008 - 7:14 am:   Edit PostPrint Post

Hello Elizabeth,
Like almost all "could it be" questions the answer is it might be possible. But it seems unlikely that the horse needed to pee that afternoon to the point it caused discomfort, then held it to that evening, then was able to pee freely. But it will take an exam to rule out such a problem.

For more signs of lameness, including a sudden onset of "stiffness", see Diseases of Horses » Lameness » Localizing Lameness in the Horse. Considering the symptoms I would consider a mild tying up episode as possible and you can still test for this. For more see Diseases of Horses » Lameness » Muscle & Tendon Diseases » Rhabdomyolysis: Tying Up, Shivers, PSSM, EPSM.
DrO
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 540
Registered: 3-2007
Posted on Tuesday, May 13, 2008 - 9:26 am:   Edit PostPrint Post

Hi DrO,

Oh, hmmm, based on the article tying up seems a distinct and troubling possibility. This is an extremely fit horse habituated to hard work; she is already fed consistent with the general dietary recommendations, though I do not supplement E, Selenium, or electrolytes.

How long after a mild tying up event will the blood test likely show elevated muscle enzymes? The article doesn't offer a specific timeframe, and we are at almost 48 hours now.

Thanks.
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 542
Registered: 3-2007
Posted on Tuesday, May 13, 2008 - 11:56 am:   Edit PostPrint Post

Update-- my vet concurred that tying-up was a real possibility, and came to draw blood. I'm instructed to work the horse during business hours so they can come back if it happens again! We should have results from the first draw today or tomorrow.
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Lori
Member
Username: maggienm

Post Number: 673
Registered: 6-2004
Posted on Tuesday, May 13, 2008 - 12:32 pm:   Edit PostPrint Post

Oh, sorry to hear this. I don't know much about tying up, I hope it is easily managed.

Lori
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Fran C
Member
Username: canter

Post Number: 1493
Registered: 1-2000
Posted on Tuesday, May 13, 2008 - 1:02 pm:   Edit PostPrint Post

What a shame, Elizabeth. I surely hope it is not tying-up and just one of those odd, inexplicable things that happen with horses some times.
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Gwen Robison
Member
Username: gwen

Post Number: 715
Registered: 6-2004
Posted on Tuesday, May 13, 2008 - 1:08 pm:   Edit PostPrint Post

Thinking positive thoughts for you and your lovely mare, Elizabeth.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20659
Registered: 1-1997
Posted on Tuesday, May 13, 2008 - 3:00 pm:   Edit PostPrint Post

Elizabeth the article discusses the persistence of the various muscle enzymes and their significance.
DrO
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 545
Registered: 3-2007
Posted on Tuesday, May 13, 2008 - 3:25 pm:   Edit PostPrint Post

Hi DrO,

Yes sorry-- I did not ask my question clearly. I should have said that my browser displays the persistence timeframes for the enzymes with a "?" in the middle, which means I can't interpret the numbers. For example, I see CPK as 3?7 days. Without knowing what that middle character is meant to be (or whether it's a browser burp and shouldn't be there at all), I wasn't certain how to read the paragraph.

My vet felt that any perceptible tying up should still be detectable in bloodwork 48 hours later, so we will see what the lab tells us.
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LL
Member
Username: frances

Post Number: 624
Registered: 3-2004
Posted on Tuesday, May 13, 2008 - 4:17 pm:   Edit PostPrint Post

Hi Elizabeth,

I think the "?" shows up in the article instead of a dash for some reason, so in this case it should read 3-7 days.

Good luck with your horse.
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 546
Registered: 3-2007
Posted on Tuesday, May 13, 2008 - 7:37 pm:   Edit PostPrint Post

Ok, Diagnostic panel is back already. I don't have it in front of me, but all values were well within normal. CPK normal range is 100-450, and my mare came back at 160. So seems unlikely that she tied up, at this point, anyhow.

Next step is a lameness exam. Thanks all for your interest.
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Lori
Member
Username: maggienm

Post Number: 674
Registered: 6-2004
Posted on Tuesday, May 13, 2008 - 7:57 pm:   Edit PostPrint Post

Well, it is good news that it wasn't tying up.

Could it possible have been a rock irritating her foot?
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Diane E.
Member
Username: scooter

Post Number: 2136
Registered: 9-2000
Posted on Wednesday, May 14, 2008 - 7:39 am:   Edit PostPrint Post

Elizabeth, when I read this I thought yup, have had a pee lameness. It was an odd thing that went on for a few mos. when I rode this horse, but every time he went "lame" he would pee like a "race horse" eventually, then be fine. Seemed like a phase he went through.

Hank gets a "poop" lameness but that's another post
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 551
Registered: 3-2007
Posted on Thursday, May 15, 2008 - 4:49 pm:   Edit PostPrint Post

So lameness exam on this mare had several findings: most significant was LF heel pain, with some additional higher pain (pastern) that seems to correlate to minor ringbone visible on x-ray. We did not pull the shoe to x-ray the hoof until we can coordinate with the farrier.

Our hind-end findings were difficult to interpret-- stifle flexions were mildly positive on both sides, but my vet felt it was more suggestive of general high back pain than problems specific to the stifles (we have prior clean stifle exams). She does look painful behind, but we couldn't localize it today.

As usual the question was more "why is she mostly sound?" than "why did she suddenly present lame behind?" though both are hard to answer. Plan is to do further diagnosis on the LF heel pain, and manage short term with firocoxib until we can get a pad on the LF. We will re-evaluate the hind-end after we think we have the front end comfortable.
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Chris
Member
Username: stevens

Post Number: 552
Registered: 8-2002
Posted on Thursday, May 15, 2008 - 9:55 pm:   Edit PostPrint Post

Bummer Elizabeth!!

I don't have experience with Holsteiners, but can say that my Dutch Warmblood also was "mostly sound" before he really went off. My thought is that he's just a stoic kind of guy; maybe your mare is too.

Best of luck to you in getting this resolved quickly.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20669
Registered: 1-1997
Posted on Friday, May 16, 2008 - 3:48 pm:   Edit PostPrint Post

When you say there is significant heel pain are you saying he reacts to the hoof-testers? It is a subjective evaluation that frequently does not relate well to pain in a source not showing lameness in that leg/foot. Think of all the non-painful things that the horse resents or resists. The other possibility is that the horse is bilaterally lame which results in a stiff gait but not obviously a front leg. For figuring this bilateral issue out see Diagnosis of Lameness which also addresses the significance of flexions. I agree the transient trail lameness remains a bit of a mystery.
DrO
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 552
Registered: 3-2007
Posted on Friday, May 16, 2008 - 4:41 pm:   Edit PostPrint Post

Hi DrO,

She reacted to hoof testers (only on that heel), and also flexed head bobbing lame on the LF. We blocked the hoof and saw roughly a 70% improvement on the flexion lameness (second block). A "collar block" eliminated the rest of the lameness on the LF. We didn't do a sterile joint block. We could not do hoof x-rays w/o pulling the shoe, so x-rayed the fetlock, which showed some ringbone at the top of the pastern bone.

Bilateral front-end lameness seems likely at this point. Her forefeet are mismatched (the P3 bones have 1.25 inches difference in length, with significant "up and down" syndrome that was not managed until recently). My suspicion is that her resulting gait asymmetry may be coming home to roost, as it were, on both forefeet.

The hind-end lameness is a tough diagnosis especially on this horse. She was a throw-out from a fancy eventing barn, with a rather shocking saddle-induced lordosis and pronounced hunter's bump. Both have improved with proper tack and rehab, but her back/croup probably have permanent damage that may make her prone to getting sore.

Our plan is to x-ray the LF when we can get the shoe removed, keep her on NSAIDs, and re-evaluate as we go along.

This all makes her sound a wreck, and in some ways she is. I feel I should add that this mare is a superb athlete with a wonderful mind and more try than most sound horses I have owned.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20677
Registered: 1-1997
Posted on Saturday, May 17, 2008 - 5:12 pm:   Edit PostPrint Post

It is a difficult history and clinical picture to draw any conclusions from. I just caution over interpreting flexion results on a leg not lame otherwise. And since blocking the left if there was no lameness on the right bilateral front limb lameness seems unlikely. Let us know how it works out.
DrO
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Vicki Zaneis
Member
Username: vickiann

Post Number: 638
Registered: 3-2005
Posted on Sunday, May 18, 2008 - 2:45 pm:   Edit PostPrint Post

These things can be so complicated. My horse's back had changed, effecting the saddle fit, causing him to carry himself in a different way. The outer left front heel kept growing faster than the other side on account of this. Farrier had to keep taking down that heel (which was sore) but it kept happening as long as I was riding frequently with a saddle fit problem. Hearing of your problem, I have to wonder about the balance of the feet and have seen some very out of balance situations upon the pulling of shoes, including on horses diagnosed with ringbone that was no problem at all once the feet were correctly balanced.
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 566
Registered: 3-2007
Posted on Tuesday, Jun 3, 2008 - 9:38 pm:   Edit PostPrint Post

Just an update on this mare.

The rapid onset gait irregularity seems to have resolved with some careful topline rehab, but she remains short on the LF, especially on hard ground.

So I had the vet and farrier out together yesterday to remove her shoe and shoot x-rays of the LF. We have x-rays from 2006 for comparison, and the changes are interesting.

What we see is mild ringbone both high and low. Not a pee lameness, unfortunately. We re-shod her with a shortened rockered rolled toe and the breakover as far back as possible. We inserted a shock pad between the shoe and the hoof-- this seems like hoodoo, but it does improve her concavity. I will keep her on firocoxib for a week and then take her off to see what I've got.

My vet and farrier concurred that she should work on soft but not deep footing-- no more gallops XC. They did not think I needed to reduce her level of training. This seems at odds with the Ringbone article, which would seem to indicate that I should back off her level of work. Dr. O, is there wiggle room in low ringbone, or is it likely that they are trying to preserve my competition season?
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Chris
Member
Username: stevens

Post Number: 565
Registered: 8-2002
Posted on Tuesday, Jun 3, 2008 - 11:20 pm:   Edit PostPrint Post

Sorry to hear the bad news Elizabeth.

Regarding the shock pads, my horse won't leave home without them. The farrier tried for the second time to take them off when she did him yesterday. This was after getting a negative reaction to the hoof testers. I took him out last night and you would have thought he was walking on broken glass. They went back on this am. I figure I'd rather wear cushy shoes than not so what the hey.

You might want to back off her training for awhile to give her some recovery time then gradually ramp back up and see what you have.

Only you can decide what to do with your competition season.

Best of Luck.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20776
Registered: 1-1997
Posted on Wednesday, Jun 4, 2008 - 8:24 am:   Edit PostPrint Post

Hello Elizabeth,
It depends on the actual lesions seen. If the history, clinical signs, intraarticular block, and radiographs are all strongly consistent with osteoarthritis of the coffin jt there is very little wiggle room on the diagnosis. If however they are just seeing some mild changes in the radiographs of the margins of the coffin jt and a foot lameness of less than a months duration then the significance of such radiographs is uncertain.
DrO
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 618
Registered: 3-2007
Posted on Sunday, Aug 31, 2008 - 12:00 am:   Edit PostPrint Post

Just an update, since other members are also struggling with front end lameness issues.

This mare now has a solid diagnosis of high and low ringbone in the LF. She blocks about 75% to the foot, and sound from the fetlock. At the time of diagnosis, she was a 3/5 on the LF prior to flexion-- LAME.

This is a relatively young (13) hot, fit and capable mare, so I have decided to try to continue her riding career, rather than retire her and watch her rot or run through/over the pasture fence.

My farrier has rockered her toe, and developed an elaborate shoe for her with a rim pad and a pre-forged wear pattern (based on the previous shoe) to assist her as much as possible in her breakover. She is shod every 6 weeks without fail. She is on occasional anti-inflammatories when she is off, typically after fruiting around in the pasture or when the weather changes suddenly.

I am under strict instructions not to jump her, and to ride her only in very good footing. I have scratched shows due to mud etc..

She now travels sound to the eye, and on a hard surface her front footfalls are now even and seem equally loud. She is competing successfully (except for leaping through the air at times). She scores 7 and 8s on her gaits, and seems happy and fit.

I suspect the lameness was coming on for a while before she showed it to us, since her overall gaits and way of going have improved tremendously since the therapeutic shoeing.

If/when her lameness re-occurs in spite of her fancy shoes, I suppose we will evaluate other therapies, and/or retirement. For now, I am hopeful that she can continue in work, with support.
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Ann
Member
Username: dres

Post Number: 1961
Registered: 10-2000
Posted on Sunday, Aug 31, 2008 - 12:42 am:   Edit PostPrint Post

Elizabeth can you post a picture of her shoes please.. I have a gelding , one in my profile, that has ring bone issues.. so far a 1/2 gram of bute a day and a aluminum shoe with a special rim pad .. http://tenderhoof.com/m_33.asp made by this company he is serviceably sound. I don't dare try to show him , 'cus some days he is more sore then others.. we have days when you can't tell he is off..:-) then we have other days where he is .5 - 1 grade lame out of 5..

On the first day God created horses, on the second day he painted them with spots..
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jos
Member
Username: paardex

Post Number: 1042
Registered: 11-2004
Posted on Sunday, Aug 31, 2008 - 7:26 am:   Edit PostPrint Post

Bet you with her character she can still go a long way![The horned ones don't give in fast!]
I really admire you for the way you handle her! Hope I get the chance to see you two at work once too.
Jos
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 619
Registered: 3-2007
Posted on Sunday, Aug 31, 2008 - 9:45 am:   Edit PostPrint Post

Hi Jos,

My vet agrees with you. On re-check she shook her head and said "It won't be over until SHE says it is. No one will ever make money gambling on the end of this mare's career."

Which is why, if you ever tire of your babysitter, you should send him to me. The C-line Holsteiners have more heart in one hoof than most horses have in their whole body! I adore my naughty mare.

Ann, we are at a clinic today, but I will try to convince her to stand still for shoe shots this evening. Her RF is interesting as well-- that hoof has poor conformation with P3 naturally at a negative angle. So she is in a custom eggbar w. a 3' wedge, equithaine, and the same type of pre-forged wear pattern.
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jos
Member
Username: paardex

Post Number: 1044
Registered: 11-2004
Posted on Sunday, Aug 31, 2008 - 11:57 am:   Edit PostPrint Post

Would love to send him to you! But what would you want to do with a gelding?
Jos
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Sara Wolff
Member
Username: mrose

Post Number: 3908
Registered: 1-2000
Posted on Sunday, Aug 31, 2008 - 12:08 pm:   Edit PostPrint Post

I don't know if you are familiar with them, or if you can work a horse in them, but if the shoes Elizabeth is using don't help your horse, you might look into Stuart clogs. Our farrier had then on Libby and she is very comfortable and moving beautifully. Just a thought.
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 621
Registered: 3-2007
Posted on Sunday, Aug 31, 2008 - 2:19 pm:   Edit PostPrint Post

Jos, I would ride him! That's why I'm gelding my 6yo stallion. Enough with the breeding-- I want to ride!
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jos
Member
Username: paardex

Post Number: 1045
Registered: 11-2004
Posted on Sunday, Aug 31, 2008 - 3:40 pm:   Edit PostPrint Post

Well Elizabeth if you pay for his transport he's yours! You can leave your stallion alone and ride one who is already gelded!
Though I personally think he would do very well until Intermediare but am not sure if Piaffe and Passage are inbred so Grand Prix is a stretch!
Jos
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 622
Registered: 3-2007
Posted on Sunday, Aug 31, 2008 - 7:32 pm:   Edit PostPrint Post

If you are serious, send me e-mail. I adore the C-line horses and would give him the best home I could. elkaufman@pollere.net is my e-mail.

Piaffe and Passage are not inbred-- they are developed from the collected trot, so if he can squat like a C-line, he can probably do it. They are very very forward thinking horses, so do not enjoy piaffe very much (or half-steps in preparation for it). Once they feel the passage, they tend to offer it all the time, often in place of the thing you asked for. Still it is fun.
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jos
Member
Username: paardex

Post Number: 1050
Registered: 11-2004
Posted on Monday, Sep 1, 2008 - 4:12 am:   Edit PostPrint Post

Hi Elizabeth I send you a private mail but had some problems with my computer, if it doesn't arrive would you mail me?
Jos
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 626
Registered: 3-2007
Posted on Monday, Sep 1, 2008 - 10:14 am:   Edit PostPrint Post

Hi Jos,

I got it and replied. Let me know if that message did not get through. Thanks!
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