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Discussion on Irregular and Intermittent Lameness

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Caroline Balch
New Member
Username: Balch

Post Number: 2
Registered: 10-2005
Posted on Saturday, Oct 8, 2005 - 5:23 pm:   Edit PostPrint Post

we have an 8 year old cob gelding 15hh. He is intermittently lame on the left fore. He will be trotting along nicely on the left rein and then put in a "hop". He then reverts to a regular trot for a number of strides before putting in another hop. He has been nerve blocked on the leg right up to the shoulder but the problem didnt go away. He will be having a nuclear scintigraphy in 2 weeks time as the vet has been unable to diagnose the cause. He says he has never seen a horse move like this and this is at the university hospital. Having read info on this site I am concerned it may be a stress fracture or navicular in which case the problem could be made worse by riding. The vet has said we should ride him becuase the problem is intermittent otherwise the nuclear scintigraphy will not find anything. Any suggestions? Help!
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Ann
Member
Username: Dres

Post Number: 624
Registered: 10-2000
Posted on Saturday, Oct 8, 2005 - 5:32 pm:   Edit PostPrint Post

Caroline, have you done any x rays on the hoof...?

On the first day God created horses, on the second day he painted them with SPOTS..
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WTG
Member
Username: Angel77

Post Number: 46
Registered: 5-2005
Posted on Sunday, Oct 9, 2005 - 1:32 am:   Edit PostPrint Post

Dear Caroline,

A friend of mine is a big shot trainer. We were at Indio one year. One of her horses had a collision with two horses that were in the warm up arena walking around aimlessly and the two riders were talking and not paying attention when they walked right into the line of this horse coming off a 4'oxer with a lot of speed.

Both rider and horse collided with the two not paying attention. The horse and rider both went to the ground like an earthquake. The emergency vet immediately took X-rays of the horses legs. Because we were at a show the vet did not have the ability to X-ray full body.

The next day everyone thought the horse was just sore from the fall. The horse was immediately sent home to recover. A couple of weeks later he seemed fine and jumping great. He went to two horse shows before anyone realized what was wrong. The trainer kept saying he is just off by a hair what could be the problem.

The owner decided to full body X-ray. The horse had a broken shoulder. We were all amazed at how he could jump with a broken shoulder.

Ended up he was on vacation for the next nine months while healing.

Today he proudly carries his 17yr old owner to many victories in the show ring.


Good Luck with your horse.


WTG
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Caroline Balch
New Member
Username: Balch

Post Number: 3
Registered: 10-2005
Posted on Sunday, Oct 9, 2005 - 8:43 am:   Edit PostPrint Post

I am told that the nuclear scintigraphy is superior to x-raying and this is happening on October 18th. Anyone any experience of this diagnostic method. And do I exercise him??
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13871
Registered: 1-1997
Posted on Sunday, Oct 9, 2005 - 2:42 pm:   Edit PostPrint Post

We have the same dilemma you present to us Caroline, we do not know why your horse is lame and therefore do not know whether it is safe to ride. In general fractures do not present as intermittent lamenesses, even in WTG's tale above the trainer could still see the horse lame. To address your specific concern of navicular fracture, it would have blocked out with the first several nerve blocks.

The problem you are faced with is "what is your best next step?". If diagnosis is of paramount importance the vets point is that if you rest it, it may cool out and not be seen on scintigraphy and we get the same recommendations here at our university.
DrO
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WTG
Member
Username: Angel77

Post Number: 47
Registered: 5-2005
Posted on Sunday, Oct 9, 2005 - 9:24 pm:   Edit PostPrint Post

Dear Dr.O,

Maybe I did not convey the story properly. The big shot trainer could not see lameness she said the horse was just not right while she was riding him. He was not his usual self.

He was not visibly lame to the eye or to three different vets. He just seemed to misstep every so often during flat work.

All I was attempting to convey is the fact that the horse did have a broken shoulder and no one knew it right away.

Full body X-rays told the tale and so it was finally diagnosed and properly treated.

Dr.O is Lymphangitis contagious?

Sincerely,

WTG
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13875
Registered: 1-1997
Posted on Monday, Oct 10, 2005 - 8:02 am:   Edit PostPrint Post

It could not have been a fracture that involved the shoulder joint directly WTG. Perhaps he had a small or nondisplaced fracture of the scapula or humerus away from the joint itself that caused minimal lameness. It would be interesting to know the exact nature of the fracture.

Though there are some causes of lymphangitis that are infectious usually they are not contagious. However if infection is the cause they should always be treated as though they were with an emphasis on not contaminating the surroundings.
DrO
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Gwen Robison
Member
Username: Gwen

Post Number: 96
Registered: 6-2004
Posted on Tuesday, Oct 11, 2005 - 7:51 am:   Edit PostPrint Post

Just to be the devil's advocate, are you sure it is the left fore? I know that for years, my horse would do a funny step (hop/hitch) every now and again. It was inconsistent and so elusive that it took four years of searching to realize that it was muscle-related and he has EPSM. I am not suggesting that your horse has EPSM, but just to "think out of the box" and not leave a stone unturned!
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Helen Gkikakis
Member
Username: Lilou

Post Number: 7
Registered: 2-2005
Posted on Tuesday, Oct 11, 2005 - 1:41 pm:   Edit PostPrint Post

Hi Gwen! Could you please tell me what EPSM is? Where can I find more info on this? Thank you!
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Gwen Robison
Member
Username: Gwen

Post Number: 97
Registered: 6-2004
Posted on Tuesday, Oct 11, 2005 - 4:12 pm:   Edit PostPrint Post

Hi Helen, EPSM is a condition in which a horse can not break down and utilize carbohydrates well. That is a VERY simplistic description. They ultimately become affected in their muscles. It is sort of like they get muscle cramps to varying degrees. If I remember correctly, you can find information through lameness, then muscle and tendon diseases. I can't check right now because this message will erase. I will double check and correct if I am wrong. There is also more information on ruralheritage.com. There are so many things that your horse could have. I don't want to send you down the wrong road. I just wished that I had this site four years ago so that I could do what you are now. Just bouncing ideas around. What I have learned through my process is that many times, veterinarians are making an educated guess. That is all they can do! I hope that is not offensive to anyone!!
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Gwen Robison
Member
Username: Gwen

Post Number: 98
Registered: 6-2004
Posted on Tuesday, Oct 11, 2005 - 4:16 pm:   Edit PostPrint Post

OOps. I just realized that Helen is a different person than who first posted. Sorry about that! You will find EPSM through equine diseases, lameness, then muscle and tendon diseases. It goes along with tying up.
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Helen Gkikakis
Member
Username: Lilou

Post Number: 8
Registered: 2-2005
Posted on Tuesday, Oct 11, 2005 - 5:07 pm:   Edit PostPrint Post

Gwen, thank you so much. I'm not sure about the name mix up you had, but thank you for your response. I appreciate it. I too have to apologize to everybody, because my questions some times may sound silly and show ignorance, but part of it is that i am not familiar with the terms in English. Sorry!
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Caroline Balch
New Member
Username: Balch

Post Number: 4
Registered: 10-2005
Posted on Thursday, Oct 13, 2005 - 4:47 pm:   Edit PostPrint Post

My horse is a hairy cob and lives on grass and hay, full stop nothing else. I thought EPSM was caused by too rich a diet. If it is muscular how does a muscle biopsy work? What is it actually testing
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13902
Registered: 1-1997
Posted on Friday, Oct 14, 2005 - 6:29 am:   Edit PostPrint Post

Hello Caroline,
Not too rich a diet per se, but an inability of the horses system to properly store glycogen in the muscles however the condition is exacerbated by high starch diets. We describe this and the biopsy findings at, Equine Diseases » Lameness » Muscle & Tendon Diseases » Tying Up, Rhabdomyolysis, and Shivers (EPSM).
DrO
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Gwen Robison
Member
Username: Gwen

Post Number: 101
Registered: 6-2004
Posted on Friday, Oct 21, 2005 - 6:27 am:   Edit PostPrint Post

I have a silly question. Since I have changed my horse's diet and began working him consistently, not only has he been looking great in terms of his muscle texture but he has also not gotten hives. He used to get them quite often. Could there be a correlation? Just curious!! Thanks.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13953
Registered: 1-1997
Posted on Friday, Oct 21, 2005 - 7:30 am:   Edit PostPrint Post

It is possible since there have been many changes in what the horse is exposed to.
DrO
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Caroline Balch
New Member
Username: Balch

Post Number: 5
Registered: 10-2005
Posted on Friday, Oct 21, 2005 - 5:06 pm:   Edit PostPrint Post

Update.}} Chester has had his nuclear scintigraphy and has revealed absolutely nothing. Vets assistant ridden him at the equine hospital and still doing his hop. They have x-rayed his neck and think only think there may be some change in bone there, with some new bone. Any ideas what this could be Arthritis? or what? Further test going ahead, bill to date £1000.
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Gwen Robison
Member
Username: Gwen

Post Number: 102
Registered: 6-2004
Posted on Friday, Oct 21, 2005 - 7:17 pm:   Edit PostPrint Post

FYI. My qh who has epsm also had some arthritic changes in his neck. Again, I feel compelled to fill you in with my situation because I believe I have seen that "hop" in my horse for years!
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13957
Registered: 1-1997
Posted on Saturday, Oct 22, 2005 - 9:37 am:   Edit PostPrint Post

It is hard to say from your description. Why not get a written assessment and put it here, we should be able to help from that.
DrO
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Caroline Balch
Member
Username: Balch

Post Number: 6
Registered: 10-2005
Posted on Saturday, Oct 22, 2005 - 12:49 pm:   Edit PostPrint Post

Hi Gwen thanks for the information. Can you tell my more about your horses "hop", is it just on a circle, or straight lines as well. Do you only notice it in trot or can you "feel" it in canter as well. Does it get better or worse as he is ridden. More or less pronounced going up hill. What has been the full history of your qh hop. is it still there with his change in diet. This may seem a stupid question but if it is muscular/cramp why does it seem to be affecting just his left fore? Any help greatly appreciated!!
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Gwen Robison
Member
Username: Gwen

Post Number: 103
Registered: 6-2004
Posted on Saturday, Oct 22, 2005 - 5:14 pm:   Edit PostPrint Post

Hi Caroline,
We used to term his misstep as a "hitch". It would mostly be on a turn, especially to the left but not always. It was also mostly at the trot. It would be most accentuated when I was asking him to sort of "frame up" and use his back to move forward. As I said, it was quite inconsistent. This added to the frustration of not only myself, but also my trainer and vets (there were many vets). He would actually often get "hitchy" when going up hills, but he was very weak behind which didn't help. The full history is in my posts entitled "unknown diagnosis" (if I remember correctly). As Dr. O said, it is so hard to compare our horses without seeing them! i am trying to be as clear as I can, but unfortunately the whole perception thing comes into play!
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Caroline Balch
Member
Username: Balch

Post Number: 7
Registered: 10-2005
Posted on Sunday, Oct 23, 2005 - 3:58 am:   Edit PostPrint Post

Hi Gwen the information you supplied has been really useful. And Chesters hop/hitch sounds very similar as it is more pronounced up hills and on corners. I cant find the route for your unknown diagnosis! Further tests are taking place this week including videsoing him and then slowing the picture right down to see what is actually happening. How is your qh now with the change of diet.
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Caroline Balch
Member
Username: Balch

Post Number: 8
Registered: 10-2005
Posted on Sunday, Oct 23, 2005 - 4:10 am:   Edit PostPrint Post

this was the first report:-
The horse was b rought to Langford with regard to his intermittent left forelimb lameness. No abnormalities were seen when Chester was walked and trotted in a straight line on a hard surface (owner - I have seen abnormalities tho in these circumstances) When moving in a circle showed very occasional exaggerated hopping steps on the left forelimb with marked elevation of the head and neck. This was more apparent when ridden. It is a somewhat unusual lameness in that he will appear to progress quite normally for a variable distance and then put in one or more exaggerated hops before resuming normally. The use of nerve blocks to the abaxial sesamoid nerve,four point block on the left fore proximal to the left fore fetlock, subcarpal block left fore, intra articular block of the left antebracheal and mid carpal joint, left elbow and left shoulder did not eliminate the gait abnormality. Recommendation scintigraphy, which has not shown any hotspot areas.
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Gwen Robison
Member
Username: Gwen

Post Number: 104
Registered: 6-2004
Posted on Sunday, Oct 23, 2005 - 6:48 am:   Edit PostPrint Post

My post was through equine disease, then lameness, then localizing lameness, then unknown diagnosis. The diet has worked very well with my horse. He used to be very tight in his muscles and the texture has changed quite a bit. He has not shown the hitch in a long time. We had a not-so-great ride yesterday and he was shorter than he has been but still no hitch. I have to keep in mind the arthritic changes in his neck too! If you are running tests, it seems like it might be a good idea to either check the enzyme levels or have the muscle biopsy done. GOOD LUCK!
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Caroline Balch
Member
Username: Balch

Post Number: 9
Registered: 10-2005
Posted on Sunday, Oct 23, 2005 - 8:33 am:   Edit PostPrint Post

Thanks again Gwen. I read your posts under unknown diagnosis. I suppose the doubt is that Chester only exhibits front end lameness whereas yours started with problems at the hind. Also he lives on hay and grass so he has mainly fibre and little carbohydrate. He is still at the university hospital and I intend to speak to them on Monday to put some of these ideas to them. Many thanks again.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13961
Registered: 1-1997
Posted on Sunday, Oct 23, 2005 - 6:45 pm:   Edit PostPrint Post

I am afraid we are stuck with a undiagnosed intermittent fore limb lameness that does not localize to any structure from the knee down, the elbow joint, or the shoulder joint. Neither is it displaying any areas of inflammation of the bone. There are still some sort tissue structures between the knees and the shoulders that have not been checked and if sounds like the hospital is considering some neurological possibilities but the head bob suggest pain on weight bearing. This is not typical for problems like Gwen describes but I certainly would be checking muscle enzymes anyway since nothing else comes up.

Let me correct one misconception: fiber IS carbohydrate but is different than the carbohydrate of grain which is called starch. The starch is very rapidly broken down to simple sugars and absorbed. Fiber on the other hand is composed of 3 different types of carbohydrates that behave a bit differently than starches. For more on this see Care for Horses » Nutrition » Forages for Horses, an Overview.
DrO
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Gwen Robison
Member
Username: Gwen

Post Number: 105
Registered: 6-2004
Posted on Sunday, Oct 23, 2005 - 10:02 pm:   Edit PostPrint Post

I have no idea if our discussion is on the right track and hopefully have been clear about not knowing Caroline's situation to make presumptions. The only thing I want to clarify is that my qh often looked as if he had a weight bearing pain, as his head would come up with the hitch. What came about that was so interesting to me, was that his head bob was as he was bringing his left hind forward. It wasn't until others really watched him closely that this was discovered. No idea what the relevance to that is...
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