Curiosity killed the cat

As most people know, I had a bit of a freak accident with Spice in August 2021. He had a very out of character rodeo explosion and I was determined there must be a pain issue. Whilst I was in hospital, he was taken to Newmarket Equine Hospital (NEH) for a full body MRI and lameness work up. Write up at the time here.

In short, there was nothing to be found bar some imbalance in his front feet and unexplained 1/10 forelimb lameness. Since I was unable to attend the visit, I never saw this forelimb lameness myself and I must admit I was a bit surprised to hear about it. I consider myself to be quite good at noticing gait abnormalities, so I was disappointed that it was something I’d not noticed before – nor did I see once I was home from hospital. However, the imbalance in his front feet didn’t hugely surprise me as Spice hasn’t been the easiest horse for the farrier and I’m certain the quality of the trim had been compromised because of this. We changed to a female trimmer not long after my accident and the improvements in his attitude and hoof balance have been marked. It was assumed that his feet were contributing to this mild lameness. Rest and re-balancing the foot was prescribed.

Fast forward to January and it was time to start Spice back up to some ridden work after spending a lot of December doing groundwork. The first challenge we faced was the saddle not fitting. Understandable really when you consider that the last time it was checked was July! With the saddler booked for the beginning of February I decided it wouldn’t be constructive to try to do anymore saddle work until it had been fitted properly.

This left us with three weeks to consider our options. More groundwork, rest or back to the vets.

I couldn’t help but feel that despite seeing three vets and having a full body MRI that we’d missed something. I know that I am a little bit paranoid, I’m obsessed with observing my horses’ gait and I worry incessantly, but I just felt that I needed one final check. The other elephant in the room is the possibility of ulcers. And this unexplained forelimb lameness that I was yet to see with my own eyes. The decision was to take him to the vets.

I’ve always been quite an ‘anti-scoper’ if that’s a thing. I just find the process awful. I hate the idea of starving them for 16hrs – it feels so counterproductive. You can also only scope for foregut ulcers and not hindgut ulcers. So you can’t even really get a full picture… added to which I strongly believe that ulcers always need a cause. Horses don’t just get them so was there a pain issue or stress?

Despite my reservations, I’d come to a point where I felt that I was having a mental block progressing his training not knowing if we’d missed something. Was he definitely 100% sound? Was he experiencing digestive pain? It’s hard enough training young horses without lots of doubts running through your mind.

I decided to bite the bullet and book him in for a lameness work up and gastric scope. I needed just one more vet (the 4th one) to tell me my horse was fine. I decided too that if we used the lameness diagnostic software at Hampden vets that it would be a computer completely objectively assessing his soundness.

It works via a series of sensors placed on the horse’s poll, sacroiliac and pastern and these feed back abnormalities in push/pull and symmetry. I use this annually on Chip at the start of the season before progressing to very heavy training. For performance horses I particularly like that it provides a baseline to always be able to refer back to year on year.

The lameness locator found Spice to be 100% sound on the straight – good news. But detected a reduced ‘push’ on the circle on the hard on the outside limb, worse RH vs LH. This lack of balance on a circle isn’t uncommon in young and unbalanced horses so what we were seeing wasn’t drastic. Luckily this reduced ‘push’ did not worsen on the soft circle. Pleasingly he was negative to flexion on all limbs/joints.

Despite Spice having a clean MRI and clean hock X-rays, conformationally (like many Arabs) he is very straight behind, and I actually don’t think he moves the best. My vet felt very strongly that this reduced push was sourced from lack of hock bend and despite not having any arthritic changes, having full range of motion and a negative response to flexion testing that he was perhaps experiencing some low-grade hock pain.

The next step was to block the hock to see if this made any difference. We saw an improvement in outside limb push on the circle on both hard and soft surfaces and so we could ascertain that his hocks were causing the guarded movement on the circle. To understand why the RH might be affecting him more than the LH we then decided to scan his suspensories and also x-ray his hind feet (as theses weren’t done at NEH).

Disappointingly, or perhaps thankfully (all depending on your perspective here), there’s still work to do in rebalancing his feet. I know that a lot of progress has been made but the LH offered far superior angles than his RH which definitely could explain the RH being the ‘weaker’ of the two in his movement.

The ultrasound scan also reflected this, as the increased straight from sub-optimal hoof angles has put increased wear at the very top of the suspensory – just where it meets the bottom of the hock. The good news – he is sound on a straight line and we have caught all of this very early.

We have an action plan;

1. Arthramid® into his hocks. It’s a long-lasting polyacrylamide hydrogel that is still a fairly novel technology for treating joint pain in horses. Clinical trials have proved it to provide an 82.5% successful resolution of joint lameness for up to 24 months.

2. Shockwave therapy (ESWT) is a therapy that has been recently adapted from human medicine for the use in horses. It has an excellent success rate in improving the prognosis of high suspensory ligament injuries. In fact, it is one of the only treatments that is effective for this injury.

3. Continued hoof rebalance. This is of course and ongoing effort but now more important than ever to full support his hind limbs. Now that we have recent x-rays and Spice is being better behaved than ever, my trimmer can be more calculated and hopefully make some positive changes ASAP.

It was quite a lot to take in. I was fully prepared to go and investigate an unresolved RF lameness but neither the vet nor the lameness locator detected one. Since he was negative to forelimb flexion and also the MRI had showed nothing of interest in front, we decided that this mystery lameness would have to remain undiagnosed. His front feet balance was drastically improved so it could well be that this has made the difference.

Overall, I feel a little that if you look for something hard enough that you will eventually find it and that’s probably what we did with his hind limbs. I guess the good news here is that in endurance we don’t do circles, we ride straight lines! So the job I am asking him to do should be within his conformational limits. Also, we have caught everything incredible early, and I am confident in the combination of the 3 strategies as above that we will be able to get on top of everything. The soundness on a straight line on a computer is a huge source of relief. The priority must be his hoof balance as I think this will be key to his long-term soundness. The vet is confident that this little bit of wear we are seeing on the suspensory can be supported better by the hoof. So, with any luck over the next few trim cycles, we should be able to get this suspensory under a lot less strain.

Onto the ulcers. Whilst all of the above was insightful and I’m so very glad I pursued it, it still didn’t explain the rodeo ride. He certainly isn’t/wasn’t lame enough to have caused the explosion. This lameness after all wasn’t even detected by the three previous vets that had seen him!

I now felt a bag of mixed emotions on whether I actually wanted him to have ulcers or not. Sounds awful I know, but I guess it was my last chance saloon to be able to pinpoint a cause. However, of course I really didn’t want him to have ulcers because I think I would really struggle to understand why. He lives out 24/7 in a herd, he has access to ad lib forage (with hay in the fields too) and he has a low sugar and starch diet – so from a management perspective there wouldn’t be much I could change or do differently even if he did have ulcers. He’s not overtly stressed in his life and we now knew that the only source of detectable pain in his body is low grade and possibly not enough to cause ulcers?

Anyway, the speculation wasn’t useful and I had a sleepless night worrying about him being starved at the vets. The scope revealed grade 1 pyloric ulcers – this is the portion of the stomach that creates a valve and allows gastric fluids and contents to enter the small intestines. The rest of his stomach was incredibly healthy with no signs of ulceration anywhere. The grading of ulcers ranges from 0 (The stomach lining is intact and there is no appearance of reddening) to 4 (The stomach contains extensive ulcers, which often merge to give areas of deep ulceration).

So once again – no answer for the behaviour. Grade 1 is not too much of a concern . Since he’s insured we decided to pursue a course of omeprazole injections to try to improve the reddening in that area anyway. My vet told me to not expect to ‘see a difference’ from the omeprazole treatment given the low-grade diagnosis but we would pursue it anyway to try to get his foregut health as healthy as possible.

So now I wonder what else could it be? Hind gut ulcers cannot be scoped for. And interestingly, the most common area to ulcerate is the right dorsal. If you remember Spice had right dorsal displacement colic in June! I have no idea if the two could be related but it does make you think?

Apparently one of the main causes of hind gut ulcers is the use of non-steroidal anti-inflammatories, (like phenylbutazone) and hindgut acidosis. Now as long as I’ve owned Spice I’ve never given him any bute so does he have hindgut acidosis? But why would he? The main cause of this is large quantities of undigested simple carbohydrates reaching the hindgut and producing lactic acid. My horses are on cereal free diets. But perhaps the colic was enough to cause a change the pH balance in there? And it hasn’t quite re-established itself yet? Anyway, clinically this is all very hard to diagnose.

My next port of call/consideration is what I can do to improve his hind gut health – as a just in case sort of situation. Based on his current feed and management routine (which already ticks the boxes) I think my strategy is going to be to add a high grade pre and probiotic supplement to his feed. My challenge is not knowing what my measure of success is going to be? He’s not girthy, he’s not poor, his coat is not dull. The only ‘symptom’ is his natural suspicion of new people, somewhat grumpy disposition and the freak accident…

In terms of treatment with the vet, Spice has now had two omeprazole injections and the Arthramid® injections. He’s having his first shockwave treatment this coming Friday. We’ll start a re-introduction to work under my vet’s guidance too.

Once we have the majority of the treatment underway I will turn my attention to booking in some lessons both in ground work and ridden so that we can really kick start the year and get our relationship back on track. I have to now accept the behavioural element of our challenges. Whilst I would have loved a straightforward answer that’s not what I’ve been given. I have pretty much maxed out all investigative areas now and have managed to amass more exclusions on his insurance policy than inclusions!

However at least now I can pursue his training without worrying that I’ve completely forgotten how to notice gait abnormalities and he doesn’t have raging grade 4 ulcers either. Our saddle fitting appointment last week was successful too so hopefully everything will be onwards and upwards from here!

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