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Dr. B.
Dr. B., Horse Veterinarian
Category: Horse Veterinary
Satisfied Customers: 1204
Experience:  Board Certified Equine Surgeon, Lameness and Sports Medicine Specialist DVM, BSc
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I have an 11 year old AQHA mare (Barpasser granddaughter)

Customer Question

I have an 11 year old AQHA mare (Barpasser granddaughter) who has had an impressive show career starting at age 2 in Western Pleasure & trail. A couple of months after I got her she started to short step on her left front but only when she was due for trimming. She seemed to be doing well with regular trimming until last spring after being hospitalized for sand colic. I had vet do a lameness workup and treat her for navicular. When she didn't get better, we took her to a lameness specialist who diagnosed a pinched nerve in her neck. She improved after that diagnosis on a recommended rehab program but is still not 100%. The vet that diagnosed her says I should give her osphos injections but I have heard a lot of negative things about it and wonder if there are other treatment options. Also this horse has gut issues. As an aside, she had a bad colitis colic in September 2014 and another (sand) colic in April 2015. X-rays showed two grade 1 ulcers and the sand. She seems much better now away from any sand and with monthly doses of sand clear and daily probiotics. However she never really has super firm poop. Any ideas about how to treat the pinched nerve?
Submitted: 8 months ago.
Category: Horse Veterinary
Expert:  Dr. B. replied 8 months ago.

Hi

I will be happy to help you with your horse. Can you tell me a little more about this 'pinched nerve'

1. How was this diagnosed? Ultrasound? Xray? MRI?

2. What nerve blocks were done? How lame was she - did they give you a grade of lameness?

3. How did you treat the navicular disease and do you have xrays of the front feet?

4. How were the ulcers diagnosed in the stomach?

Looking forward to working with you and awaiting your reply.

Customer: replied 8 months ago.
1.) The pinched nerve was diagnosed with x-ray and ultrasound.
2. & 3.) The nerve blocks were used on both front legs by one vet initially and isolated the hooves. This vet said she had navicular and recommended special showing and injections of both navicular bursas. The lameness did not improve even slightly. So after about 6 weeks, we took her to a lameness specialist outside of our area and he repeated the nerve blocks on both hooves and moved up to her entire front left leg. He also watched her move and said she did not move like a foot sore horse. I do have the x-rays of her front feet and those that were done of her neck. The specialist injected her neck and she did show some improvement but not 100%. This vet recommended that we come back for the osphos injections but I didn't have the extra money and wasn't sure I wanted to risk it with her colic issues as I'd heard that many horses colic after being injected.
4.) She colicked the first time in September 2014, just two months after I got her. The diagnosis was colitis but there was no cause that could be determined and we didn't do further tests at that time. The second time she colicked was in April of 2015 and this time she displaced and nearly had to have surgery. This time after she got better and before she was released from the hospital we had her x-rayed and scoped. The x-rays showed a lot of sand in her gut and the scope is what showed the two grade one ulcers. She was treated for the ulcers with ulcergard and given massive amounts of psyllium powder for about a month or so for the sand and then repeated the x-rays. The sand had gone down significantly, so she now gets one week of sand clear per month. She still has slightly soft poop. No vet has seemed to determine why the poop is this way, but she seems OK otherwise. I board at a large public barn with a lot of variation in hay quality, so since the last colic, I buy all my own good quality grass hay from a local supplier and feed her in a slow feeder twice a day.I'm attaching the x-rays from both vets. I have 4 more files to add so will have to do them under separate email as I've gotten to the limit for this email.Thanks for your help. When it comes to people, it seems you can get additional opinions from doctors without issues but the veterinarians seem to be offended when you ask for a 2nd or 3rd opinion. One recently told me he knew what was wrong and how to fix it but when he found out I'd already been to other vets, he has refused to see her. Let me know if you need any additional information.
Customer: replied 8 months ago.
Hi:Here are the rest of the x-rays from the specialist. I'm also including a few files of her moving, so you can see how she is off. The specialist I went to actually was able to tell she wasn't foot sore just by looking at the videos which I had sent to him along with her foot x-rays before I took her to see him. Thank you so much for your help. I've never tried an online veterinary service but after having that local vet tell me he knew how to fix her and then wait until the day before the appointment to cancel, I've become really frustrated. I love this mare and have spent a fortune in vet bills for her and she is still lame. She is actually not as bad at the walk and lope, but the slow jog is the worst. Another note is that when I first got her she was trippy outside the arena but never missed a step in the arena. She is on the lazy side, so just thought that was it but she has improved a lot and is now much better outside the arena so long as her feet are trimmed. Here is link to a video of her lunging when we first noticed the lameness in August 2014: https://www.youtube.com/watch?v=2YbYjcetVtc This is at a show in September 2014 -- she colicked right after this show with the colitis. https://www.youtube.com/watch?v=9GI3JOfW3yg I am attaching the video of my test ride on her in June 2014. Hope this helps.
Customer: replied 8 months ago.
I saw that you had another question about how the pinched nerve was diagnosed and I believe it was with x-rays and ultrasound records which I just sent you.
Expert:  Dr. B. replied 8 months ago.

Hi again,

Thank you for all the additional information - this is great to help me give you an opinion.

As far as the navicular disease, your horse does have some very mild navicular bone changes on the xrays that could be related to the pain but xrays are only 50% predictive of pathology (source of the damage). The lack of response to nerve blocks and lack of response to bursa injections would indicate that the navicular issue is minimal in relation to the lameness. Also, the navicular bursa injection on the right was actually into the coffin joint but it wouldn't matter as there is 90% diffusion between the two - just an incorrect technique.

The diagnosis of the cervical vertebra facet arthritis (pinched nerve) looks to be correct based on the xrays and ultrasound. The 'pinching' of the nerve is due to the inflammation caused by arthritis that is occurring at the small joints that connect the vertebra together at the top and bottom of the vertebra in the neck. This inflammation causes swelling of the soft tissues (ligaments and muscles surrounding the vertebra) and this compresses the nerve roots that come out of the vertebra on their way to the leg. This results in the lameness. It looks like your horse has affected sites at C4-C5, C5-C6 for sure and then potentially lower as well. This has been treated appropriately by the specialist you have seen by the sounds of it. The difficulty with this condition is that the arthritis cannot be stopped only controlled with injections or some other options as well. This is where your specialist is suggesting Osphos. Osphos is a newer drug on the market (the original medication was called Tildren). These medications were made for the human market to prevent osteoporosis - stops bone breakdown. Tildren was originally used to treat navicular disease with the thought being that we could stop bone breakdown of the navicular bone if we used this drug. It worked 'ok' for navicular disease depending very much on the type of bone changes that we saw on xrays (not all vets were up on this and it got used a lot without any good science or proper diagnosis). Some people became frustrated with it for sure as it was very expensive when they first started using it and it had a small risk for causing a temporary colic in horses (I've seen it and it is not that bad and I have never had to take one of my horses to surgery for it or anything). In the past year, a different company came out with this new drug Osphos to compete with Tildren. The big difference is Osphos is intramuscular whereas Tildren is IV injection. Most of the hype with Osphos is marketing - it still has the limited used that Tildren does. In the past year and a half, some vets have been experimenting with using it for arthritis (particularly in the hocks). There is no science to prove this use yet but there is some subjective evidence that it may work to help decrease the rate of arthritis development but it does not stop it. I have used it for this purpose and maybe seeing some differnence but you will still need to treat with steroids in and around the joints (in your case the facet joints of the neck). So, I don't think an Osphos treatment will do any harm. The risk of colic is low (but does still exist with Osphos) and is manageable. Otherwise, I would recommend corticosteroid injections of the facets to decrease the inflammation and allow the nerve roots to heal. This may be an ongoing issue though for you given the xrays.

The issue of the loose stool is due to the sand. I worked in AZ for a while and saw a lot of colic due to sand. Even a mild amount of sand rubbing in the large colon will cause some loose stool but as long as there are no colic signs and no fever associated with the loose stool then you can continue as you are with the psyllium in the feed. Some horses never completely clear the sand and others will. We saw hundreds of these horses and surgery was not commonly needed as long as you maintain what you are doing. The other important things to do are to ensure that you are feeding off the ground and have a mat or concrete under where you feed to avoid them picking sand off the ground when eating. I hope this information is helpful. With treatment this should continue to improve but certainly realize that arthritis is progressive and will worsen with time - the timeline is just very difficult to determine - probably years though. All the best!