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  Discussion on Body Bone Scan (Syntography)
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Member:
Craven

Posted on Tuesday, Nov 5, 2002 - 3:02 pm:

My 6 yo maiden mare has been brought into work this year and is tripping on the left hind at walk. Also throws her head about at walk. She finds trot gait easier but does not track up on the left hind. No problem at canter. She is completely sound unridden. There is muscle spasm on either side of the spine from behind the rib-cage to insertion at the pelvis. She has been x-rayed along spine - no problems. Bone density scan shows two 'hot spots' 1st middle of left hip bone. 2nd left stifle. Any ideas?
Moderator:
DrO

Posted on Wednesday, Nov 6, 2002 - 4:27 am:

Hello Norma,
Is the tripping and head throwing occuring all the time or just under saddle. Can you describe the muscle spasms better? What do they look like and when do they happen? What breed is this horse?
DrO
Member:
Craven

Posted on Thursday, Nov 7, 2002 - 10:04 am:

Tripping is happening once or twice during one hour hack over uneven ground at walk. Horse described here in UK as a 'daisy-cutter' that is does not lift any hooves high off ground in walk pace.
Head throwing is just under saddle at walk. All other paces mare works in outline. Best pace canter - really brings hocks uner her,lovely forward going action and outline. Trot - on left circle shortens left hind every five paces or so.
Mare does not display other signs of discomfort and is very kind and willing but feel as not going forward in walk and over bending in trot.
Teeth been done twice.
Long muscles (7cm width)immediately on either side of spine stretching from rear rib-cage to insertion on centre line pelvis in constant spasm.
When physiotherapist releases they return to spasm within minutes.
Ridden with slow-releasing gel pad and decent fit hunt saddle.
Home-bred by Belgium Warmblood out of Thoroughbred mare. Both high achievers with no known problems anywhere.
Always had problem 'picking out' left hind hoof from birth. Now associate this with problem on left side of pelvis and centred 'hotspot' on this side picked up by scan.
Have put on glucosamine, MSM and herbal anti-inflammatories.
On pharmacological 'bute' was much improved over 3 day trial period.
Norma
Moderator:
DrO

Posted on Friday, Nov 8, 2002 - 6:47 am:

What does the spasm look like Norma: how do you know these muscles are spasming? Can you see the muscle fasiculating just watching it? What does it mean to have trouble picking out left hind foot?
DrO
Member:
Craven

Posted on Friday, Nov 8, 2002 - 12:29 pm:

When a pen is pushed down and run down her back on both sides adjacent to the spine she does not react until behind the ribcage. Then she shows obvious discomfort dipping her back down away from the pressure. The muscles above the lumber transverse processes are not fasiculating but are very hard to the touch that is contracted and won't release except after physio but only relaxed until she moves to the other side of the box. Picking up the left hind has always been problematical. I put it down as a quirk but as she has turned out so honest and kind I strongly suspect the left side of the pelvis (given the 'hot spot' showing on the bone scan)perhaps the joint is out? In which case chiropractic manipulation might help? She has now been seen in action by 3 Vets but we are not any further forward!!!!
Many thanks for your help. Norma Abel
Moderator:
DrO

Posted on Saturday, Nov 9, 2002 - 1:43 pm:

I find the pen test totally unreliable and many sound horses will react in unpredictable ways to any semi-pointed (including the tips of the fingers) object run down the back. If you experiment with the other horses in the barn I think you will find this true. Also, a well established principle of bone scans is that hot spots do not correlate well with areas of pain and the lack of hot spots does not rule out lameness, particularly chronic joint pain. There are many reasons for increased metabolic activity in a bone. This is becoming such a common problem to explain I will write up an article this week on this.

Here is the problem as I understand it. You have some pretty well defined problems with poorly defined causes. There is some feeling by those who have examined this horse that they are related to back troubles but hard proof is not there and there are other possibilities. I think the reaction to bute is most interesting as it makes "training issues" less likely. I would want the left hind gait abnormalities pursued more aggressively than you have indicated so far, with progressively higher blocks in the leg until I was convinced the problem was not in the hock or below. If you have someone with very good techiques I would also try to block out the stifle. For more detail on this see Diagnosis of Lameness in horses.
DrO
Member:
Craven

Posted on Sunday, Nov 10, 2002 - 12:37 pm:

Many thanks for you advice. Interestingly, I already spoke directly with the Vet Practise that deals with the racehorse community in Newmarket, England. The Vet there knows the other 3 vets involved and has informed them he is willing to take the case. They have agreed to this. This case is unusual. I like the mare. She is insured You have informed me of the road to travel to identify the source of and treat the problem. I shall keep you informed! Many thanks, Norma

One final question. The Vet who performed the body scan said wait 6 weeks (now 4 weeks) before re-evaluating given the steady exercise, MSM & glucosamine. Should I take her to Newmarket sooner for evaluation.
Moderator:
DrO

Posted on Monday, Nov 11, 2002 - 7:44 am:

It depends on your goals and budget Norma. Statistically 80% of acute problems will resolve in this time frame. Can you afford to wait, can you not afford to wait? If it was me I would be using something with proven useful antiinflammatory action, like bute, and skip the MSM and allow the horse to rest or at least a light training regimen.
DrO
Member:
Craven

Posted on Tuesday, Nov 19, 2002 - 1:39 pm:

Thanks for your advice. In the UK Insurers routinely exclude the parts of the horse claimed as Vet's Fees and Treatment from renewal. As Ginger's renewal is mid-December 2002 I have really no other option but to go for optimal veterinary resolution now for this problem.
So I intend to spend the Insurers liability regarding Vet's Fees cover and hope that by switching to the Newmarket 'racehorse' Vet who sorted Oscar's three short torn ligaments via arthroscopy (I posted you about this under OCD). If this does not produce results then I shall closely follow your advice - which seems perfectly sensible to me.
Bute plus grass rest until next spring. After all, I only want a reliable pleasure riding horse which her kindness and genuiness fulfills.

How much bute should she be given daily? And for how long without adversley affecting her liver?Can herbal 'anti-inflammatories' be used instead? Finally, why are you saying 'skip the MSM'?

Thank you for creating this site which really allows an owner much greater insights into what is going on within their horse. It really is positive and removes the 'doom and gloom' of not knowing all the treatment routes that are available to make the most sensible decision.

PS Oscar was very, very close to being destroyed. I had agreed a mortality value with the Insurer. After discussing with you the accuracy of radiographs in the diagnosis of OCD I decided to go for the arthroscopy to find torn ligaments and full recovery for my 3yo. Without any doubt he owes his life to your web-site as 3 vets gave such a poor prognosis of OCD on the x-rays. Thanks again, Norma
Member:
Craven

Posted on Tuesday, Nov 19, 2002 - 1:47 pm:

Forgot to mention have requested nerve blocks in sequence you recommended. Also, have given details of your Web site to my Vet, Linda Belton. Seems interested so look out for her. Norma
Moderator:
DrO

Posted on Wednesday, Nov 20, 2002 - 8:43 am:

Thank you for the pat on the back, sometimes you get lucky. Run a search on MSM, this is a often discussed subject that I should put together in article form. There are no herbal antiinflammatories with well developed characteristics in horses and concerning bute dosage and toxicity see:
1) Equine Medications and Nutriceuticals » Anti-inflammatories, Steroids, and Arthritis Treatment » An Overview of NSAID's
2) Equine Medications and Nutriceuticals » Anti-inflammatories, Steroids, and Arthritis Treatment » Phenylbutazone
DrO
Member:
Craven

Posted on Monday, Nov 25, 2002 - 5:27 pm:

Dear Dr O.,

In my experience of life in general, luck has little to do with evaluation, expierence, and conclusion based on experience and judgemental decision based on knowledge, descriptive factors of, and consequential diagnosis based upon them! You have enough insights for me to ask your for advice again without any recourse and/or liability. I just want best advice for the mare.

Please can you review the following letter from the reporting Vet.

I should say, now I believe a course of daily NAID's + rest till April will work just as well as taking the mare all over the known universe for profound diagnosis. I do not think we will get this as symptoms are diffuse in the extreme.
That is, if it was sacro-iliac then there should be the 'signs of Celsus'. There are none. The signs are only under hunt saddle ridden at trot on the left rein. And then only either stride of every 5th stride (which is a half stride) and leads to the tripping (in my opinion).

Leaving out formalities the referral letter states:-

This horse was admitted on 22 Oct 2002 for scintography exam specifically the spine & hind limbs. Previous history indicated poor movement behind and tendency to stumble behind.

Scintography was performed on 22 Oct 2002. Areas of slightly increased uptake included the left fore shoulder and navicular regions, the right fore carpus and the left hind patella and tibia. There was diffuse uptake over the axial wing of ileum area, possibly indicating some strain to the attachments of the sacro-iliac area which explains the poor movement behind. The spine and dorsal spinous processes over the withers were unremarkable.
Conclusions: There are several areas of slightly increased uptake in the ileac wing/sacro-iliac ligament and this is worthy of further investigation.

Today, they said to Linda, the referring Vet, the mare should have 'cartorphin' injections? Forgive my spelling but what do they mean? Plus a regular excercise programme plus re-evaluation! What do they mean?

As stated this goes no further in your advisory terms and I only want a pleasant 'hack'. Norma
Moderator:
DrO

Posted on Tuesday, Nov 26, 2002 - 6:11 am:

Cartorphin...I wonder if this could be cortisone? If so see » Equine Medications and Nutriceuticals » Anti-inflammatories, Steroids, and Arthritis Treatment » Overview of the Steroidal Anti-inflammatory Drugs. A number of products are used and if the area of inflammation is localized methylprednisolone can be injected into the sore area (the article explains more about these).
DrO
Member:
Craven

Posted on Tuesday, Dec 3, 2002 - 2:33 pm:

Ithink we,ve got the 'head-throwing sorted by her teeth. Time will tell over this one, but Ginger's tooth rasping was, on both sides very much over slanted from right to left. I, along with my driver experienced this first-hand.

This would explain head-throwing at walk. She was uncomfortable.

Next situation, which happened first, woman's logic only! Was the Chiro did nothing but asked 'Is she hopping'? I said yes. He asked me to go on my knees in front of her knees 'different bone names I know' and look through to her hocks. Immediately, I could see a difference. So much increased bone activity below the left hind joint - has this been the source of the problem? His view 'Well she's a Warmblood Cross - late maturing at 6 - look at the thoroughbred's hocks (5) 1 year younger you've brought. Out of the same mare. I did. Never seen such a difference between hocks below the joint before. Asked what I should do? He said 'Work it through - both sides need to balance - a bone building exercise that Warmbloods are slow to do. Given that they are slow to mature mentally then 6 is not unreasonable is it for growth'. The younger sister is a full thoroughbred and had her marbles about her since 2 years. Ginger (1st foal I bred)has been noticably slow in all aspects. I have really waited for her to mature mentally which she has now done without any doubt. This is a decent animal otherwise I would not be on your Web-site. There are no problems other than previously reported and no obvious signs of pain/disinclination over any purpose at any stage. The left hock joint is not inflamed. There is a discernable, but uniformly matching, increase in size of bone to the inside of the left bone below the hock joint. She is not sore at all. All signs are that she feels very good.

norma abel
Moderator:
DrO

Posted on Wednesday, Dec 4, 2002 - 4:10 am:

Good Luck on the head tossing. I am not sure what to make of the chiro's comments and your observations. Though there have been many growing warm bloods in the practice over the years, and having raised a few myself, I have not observed anything quite like you describe.
DrO
Member:
Craven

Posted on Thursday, Dec 5, 2002 - 9:58 am:

Chiro recommends 'trail edge shoes on both hinds 3/4 shoeings. Changes going on in spavin areas. Lower inside right hind. Upper inside left hind. A mystery as I've never encountered myself? Head and hind different issues. Can sort head as can teach her to stop now realise not connected. Could this be a growth spurt of bone to adjust to working from behind and adjusting to weight on back and bringing hocks under.

Will leave posting for 8 weeks to inform on regime results of attempting to work through.

Regards, Norma
Moderator:
DrO

Posted on Thursday, Dec 5, 2002 - 4:33 pm:

Since he describes it, whatever it is, as assymetrical I do not think this is part of growing. I would have your vet review and consider some radiographs if there really are observable or palpable changes around the joint.
DrO
Member:
Craven

Posted on Saturday, Dec 7, 2002 - 11:26 am:

DrO Since last spoke was contacted by my Vet's Maternity replacement. Guess where she's from and qualified Belgium and guess what Ginger is a Belgium Warmblood cross TB. So she is very familiar with. Apparently the gene pool for BWB is small giving rise to in-bred genetic faults.
BWB notorious for 'hopping' when brought into work.

She is familiar with what described and get feeling she's after resolution too. Radiographs of hocks essential now as you point out.

Stifle has been radiographed but nothing to report. Was not told this!

Cartrophen previously mentioned to you is small animal drug in UK currently being licensed for use in horses. Here used in place of hyonate injection for repairing fibres in ligaments.

I bet you this is all this nonsence is a 'spavin'. She is sickle/cow hocked. Vet going to perform several soft focus radiographs this week> Bet regime is continuous work plus bute!

Any advice before procedure on Wed 10 Dec 2002 gratefully received as applies an extra expert brain to a problem ongoing from mid-Sept.

PS +ve head-throwing very minor independent issue I allowed because wanted her to find own balance + thought all inter-connected.

Thanks again for the interest as has motivated me.

Norma
Moderator:
DrO

Posted on Monday, Dec 9, 2002 - 7:24 am:

Hello Norma,
Though arthritis (spavin) is a radiographic diagnosis, pain from spavin is not! Many horses with radiographic evidence of spavin, sometimes severe, are not lame. Block those hocks before you radiograph them. For more see the article on radiographic interpretation.
DrO
Member:
Craven

Posted on Wednesday, Dec 11, 2002 - 11:06 am:

As suggested hocks blocked but no difference to movement on left circle. Same right circle.

Examined genetics- no obvious inbreeding/history.

Diagnosis now is left sacro-iliac ligamant strain. 10ml Cartrophen Vet injected. Each ml contains 100mg Pentosan Polysulphate Sodium. Interval 10 days max 4 doses. Semi-synthetic polymer with anti-inflammatory activity and modulating effects on cartilage and synovial metabolism + affinity for cartilage. Has fibrinolytic, lipolytic and mild anti-coagulant activities.

Advice to keep horse in daily hill-work to build muscle but no schooling work. Review in 6 weeks.

Has spavin left hock. No inflammation. Also put sterile needle in joint but no fluid exuded.

Sacro-iliac ligament strain - any thoughts?

PS Now seen by 5 Vets (3 same practice - 2 referred on to) all saying same thing. As insured will continue with regimen but can't get the 'big picture' on this at all?

Regards, Norma

Moderator:
DrO

Posted on Wednesday, Dec 11, 2002 - 8:50 pm:

What is so hard about a vet saying, "I don't know". That really is the truth here. There are still dozens of other possibilities and until blocked the stifle is more common a cause of lameness than the SI joint. Interestingly just last week there were two talks at the Am Assoc of Eq Pract meeting that concerned themselves with SI pain. A diagnostic technique that involves regional anesthesia using very long needles was presented. In a case review the remarkable thing about SI pain seemed to be how much worse these horses were under saddle these horses where particularly at the canter.

Until someone either finds a unarguable lesion (there are very fews of these) or blocks out the pain: the cause, the proper treatment, and the prognosis are uncertain. When uncertainty occurs, and this occurs often in practice, rest is better in my opinion. We could argue over whether this means stall, paddock, or pasture rest. I prefer paddock plus a antiinflammatory drug.

Best is referral to someone who has the skills to logically continue to localize and diagnose the problem.
DrO
Member:
Craven

Posted on Saturday, Dec 14, 2002 - 11:21 am:

At exactly the same conclusion here and have found a Vet with good experience. Am seeing at end Jan 03.

Your site is excellent but do you have anatomial + skeletal diagrem of horse. This would help lay people think through and discuss more accurately.

Have a great Xmas/New Year. Thanks for all your insights and most of all 'sticking with it'.

Taken all to heart. Regards, Norma
Moderator:
DrO

Posted on Sunday, Dec 15, 2002 - 11:16 am:

You will find illustrations of the skeleton and other structures of the horse at » References » Equine Illustrations » Leg Anatomy and Conformation. The illustrations of the whole leg show the overlying skin contour.
DrO
Member:
Craven

Posted on Monday, Jan 6, 2003 - 11:14 pm:

Dear DrO

Moved Ginger to Horse Yard known to me in December to friend and serious Dressage rider with own foal brought up to high level. Told her all except head throwing. After 4 weeks in our home in Cape Coral last 3 years, Florida (want to retire there and take Ginger trail riding on Pine Island) came home to England. Saw Ginger in action today. No head-throwing in walk so think even teeth rasping both left and right hand did have a positive effect. Then saw her in trot both reins. Great action both reins. Picking her feet up. Loads of action behind. Energetic, happy on bit, calm, interested. Unbelievable from what reported to you. Relaxed, happy, mouthing, bending, slightly stiff on left rein. Put on weight. Noticable build of muscle behind on rump. No ribs showing. On working - Noticable picking up off all legs - in fact springing in all paces. Different animal from before. Diet different. UK Brand Bailey's No 1 & Gro' & Win. Plus Sugar Beet, Bran, Linseed Oil, Glucosamine, Garlic, MSM & herbal non-bute supplements + all she can eat quality hay. Working well on bit, salivating, contented, tracking up. No tripping, head-throwing, shortening strides in trot. Ready now for me to ride. Have arranged 5* vetting this week. If fails will advise but on todays action could not fail!!! Paying self for this. Insurers at moment will not pay out as say 5 vets (3X1 Practice 2X Referral have not diagnosed any problem other than lameness). I have paid full livery cost and worked hard on exercise and diet to resolve myself, taking excellent advice from you (except could not get stifle blocked as Vet's here felt unqualified to do). To the point I said to John, my husband of 17 years, I felt 'stifled' myself. But mentally this animal is 100% so worth the effort. Now paying off. Except the Insurers atitude which I have never experienced before. Most are pleased with a good result. These will not pay out as they claim no diagnosis? This is the 1st claim with them in 3 years of insurance. A bit tough I think. But I have read the Terms & Conditions and Ginger is worth the fight if 5 Vet's have termed her 'lame' in their Invoices!

Love your Site postings. Busy with 3 company's, 2 UK, 1 US. I want US Citizenship so will learn US history for Exam. Want to retire to house, owned 2 1/2 years in Cape Coral, Florida with husband, John & trail ride Ginger on Pine Island. Kids, no wonder, thinking of College/University in Cape Coral (Paradise).

Spent 3 years studying Vet Med at Glasgow Uni, Scotland. Failed Pathology 3X so thrown out!
Got Distinction Anatomy. Took a long time to get over failure though succeeded in everything after!

Love your site. Especially postings. Relevant to every equine owner. Almost overwhelmed with the info tho'. Husband insists if spent time on our business could be much richer!!! Your fault. But thanks 'cause Ginger better for it.

Kind regards & great & peaceful 2003 to you, Norma

Board Administrator
Username: Admin

Posted on Tuesday, Jan 7, 2003 - 10:01 am:

Thank you for your kind words Martha and may 2003 bring you peace and happiness.
DrO
Member:
Craven

Posted on Wednesday, Jan 8, 2003 - 10:28 am:

Dear DrO

This is close-out.

Ginger had a 5* Purchaser's Vetting today (the toughest you can get) by an experienced Vet recommended to me and from a different Practice.

I gave no history but asked many questions! Primed by your site and our deliberations you see.

Cost me $200 but she passed with flying colours.

I've learnt Vet Med is not an exact science and also to keep an open mind and be ready to try alternatives.

Bye the way (see your previous message)my name is Norma but my husband calls me Martha. Deja vu?

Hope not to have to open another Posting. Just want to enjoy your web-site and e-mails which are brilliant - eg warm V cold drinking water etc.

Kind regards and thanks for expanding my mind-set.

Norma Abel
Moderator:
DrO

Posted on Wednesday, Jan 8, 2003 - 8:47 pm:

Most excellent NORMA (excuse me above). You are right, when it comes to lameness and many conditions of horses to know for sure is either VERY expensive or sometimes it does not matter how much you spend, the techonology is just not there. Huge strides have been made to improve the situation since I became a vet.

What troubles me most is when dire predictions are made with incomplete information and unproven treatments are foisted on patients. We vets need to become more knowledable about what we don't know, from that point progress and serving our patients is much easier.
DrO
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