Dire Predictions

Yoshi went lame last Friday. Ironically, my friend was coming out to ride him to reacquaint herself with him so she could hack him over the weekend while I was at work because her horse is currently on stall rest. I felt a few funky steps on the left front while trotting left, but pushed him through it. 

But when she got on he looked lame. When I started him back to work in May, if I pulled on the inside rein while tracking left, he would go rein lame. I verified more than once with Ms. GY watching to confirm that when I tossed him on the lunge he trotted sound. And this eventually went away. So I had my friend get off and we put him on the lunge. Where he looked lame. I palpated his entire leg and other than his perpetual dislike of having any of his suspensory ligaments touched, he had no swelling, heat, or pain. Mr. GY watched and noted some swelling in the area of his right pec. We worked a bit on mobility on both front legs which he initially resisted and then relaxed into. 

He had the weekend off and then I tossed him back on the lunge Monday morning. Still the same degree of lameness. I put in a phone call to the lameness vet that JT recommended and he was able to come out Tuesday afternoon. It ended up being "the longest vet appointment I have ever seen" according to my husband. The lameness vet started by watching and palpating. He said that with the sensitive TBs, you sometimes have to call their bluff on the suspensory and managed to palpate that more successfully than I had without much reaction. He found it odd that the lameness was equally bad tracking left and right on the lunge. He blocked out his distal limb without much improvement in the lameness. Which left him thinking either proximal suspensory, neck, knee, or zebras.

He asked if I wanted to keep going and I did, so Yoshi got a light dose of sedation, and we moved on to imaging. He shot rads of his knee that looked great (this horse is working on being the most radiographed horse of all time). He took foot rads (for his own interest, I was not billed, I'm not sure what that interest was, he didn't explain) that showed an ever so slightly positive palmar angle (hooray!). He ultrasounded his suspensory ligament and did not find any lesions. He ultrasounded some of the structures just proximal to the knee and did not find zebras. He ultrasounded his neck and identified the right-sided chip that the chiro vet had found. The left side looked better, but there was some mild OA there. The ultrasounding of the neck is so interesting, you can only see about 15% of the facet joint, but it is more sensitive than rads. Most sensitive would obviously be MRI, but there's the whole expense, time, getting a horse into an MRI, etc. 

Then he asked me what I wanted to do. I told him I needed to be given options and then I could choose. He said we could do NSAIDs and time off or that we could try injecting the neck. He said if we went with rest/NSAIDs he felt he probably would be back out after he went back to work and went lame again. I tended to agree and really wanted an answer (yes, I know that isn't always possible in lameness things...) Yoshi was given an extra dose of sedation and we moved ahead with injecting the neck with steroids. It was SO COOL to watch. His neck was sterilely prepped and then he used the ultrasound to guide the injection into the facet joint. He did C5-C6 and C6-C7 on both sides. On the left side C6-C7, synovial fluid flowed back out of the needle after he placed it into the joint - apparently any synovial fluid is significant, so this told us there was synovitis in that joint. He aspirated the fluid so as to not increase the pressure in the joint and then injected the steroids. 

Yoshi is now off until Monday when I can start lightly hacking him. If he is improved, great. If not, we start again. If he initially responds but then worsens again after a short duration (<6 months) then we may talk about orthobiologics ie alpha-2 macroglobulins or prostride injections into the joint. Prostride apparently runs ~$800 for the amount that would be needed to go into one joint, so we would likely focus on the left C6-C7 if we went that route. However, he had a lot of good things to say about alpha-2 macroglobulins, so I think that would be the more likely choice. 

I've been reading up on cervical facet OA and it seems to be a mixed bag. One paper had 71% of horses returning to their prior performance level, but the duration of time before needing repeat injections varied from a few months to a few years. Another, with only 8 horses, had 64% of them returning to or exceeding their prior performance level. The durations of response were longer in horses of this group.

I sometimes question putting this all out on the world wide web when, soundness issues aside, I have openly admitted Yoshi may not be a forever horse. But I would be forthcoming with any potential buyers on what he has dealt with and what we have done to keep him sound. Selling him without disclosing all that would be doing him a disservice.  

Side note, I've now gotten three different Adequan protocols from three different vets. It is labelled for 7 injections, 4 days apart. Everyone has agreed to do that loading dose to start. But then: 

1. Repeat that loading protocol every 6 months. This is the way it is labelled, this is the way it was shown to be effective. 
2. Give 1 injection every 2 weeks. This maintains therapeutic levels in the serum. 
3. Give 1 injection a few days before every time you compete. A lot of people down here do compete every 2 weeks during the show season, so this may amount to the same as option 2. 

Anyone have any other favorite protocols to offer? I ended up restarting a loading dose on Yoshi and then I'm going to go back to the every 2 weeks. I may repeat the loading once a year in addition. Who knows.