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Member:
Heidih

Posted on Monday, Apr 11, 2005 - 10:26 am:

Hi Dr. O,

I posted under this topic last night and it looked like it showed up before I logged off. Now it's not there. Do you know what happened? I hate to retype the entire message if it's in the system somewhere.

Thanks a bunch

Heidi
Moderator:
DrO

Posted on Monday, Apr 11, 2005 - 12:36 pm:

Hello Heidi,
I went and searched your name for the last 3 days and this was the only post that showed up. Neither did I receive a email notification in my email this morning. Both suggest it did not go through. I am sorry.
DrO
Member:
Heidih

Posted on Monday, Apr 11, 2005 - 2:07 pm:

Dr.O
Thanks for looking.

I have a 7 YO Arab mare that has been tentatively diagnosed with a pelvic fracture or Sacro Illiac injury. She's been in training for Dressage, at the lower levels, for about 6 mos., being ridden 3-4 times a week for approx. 1 hour.

She started showing lameness about 2 weeks ago. A significant shortening of the stride on the left hind at the trot. She almost won't trot at all. The hind leg is almost making a circular movement out to the side, instead of coming up straight under her. I called out the local vet because I thought she had injured her stifle. He blocked that leg up to and including the stifle, with no change at all in her gait. That led him to diagnose a pelvic or hip problem. He admitted that he's not the best lameness diagnostician and recommended a 2nd opinion. He felt x-rays would not help in that location. Especially with the portable unit he has.

I called out a 2nd vet, who is well respected in our area for lameness issues. She also does chiropractic work. She evaluated my mare, but didn't repeat the blocks of the hind leg. She agreed with the first vet, that there was a pelvic or sacro-iliac problem. She said the mare may have a hairline fracture in bone in her pelvis, although she didn't feel any crepidus on palpation, or may have somehow pulled or strained a muscle very badly up there. She recommended a trip to the Univ. of WI for a nuclear scan to pinpoint the problem. She did point out that in the 2 weeks since the onset of the lameness, my mare has some muscle wasting on the left side, probably due to not using the leg correctly. She said that if it was a different horse, she'd recommend stall rest.

I was wondering if a Nuclear Scan, which is pretty expensive, not to mention the 3 hour trip each way, is worth having? Will it change the treatment to find out the exact diagnosis?

Here comes the rest of the problem. My mare most likely injured herself in the stall. She gets very anxious when she's in a stall and a horse anywhere near her (whether or not it's a horse she knows) gets taken out of their stall for work. The horses are turned out during the day for about 7 - 8 hours. My mare would kill herself trying to get out of the stall if she was the only horse in the barn. Even if you bring her in the barn during the day to work with her, she is very stressed. She takes out her stress by violently banging her hips against the stall wall, hence probably causing the injury. Her stall walls are padded with light weight mats with foam behind them, to try to decrease the amount of force applied to her hip. I'm in a boarding situation, so my options at that barn are limited. There isn't another horse I could leave in with her, and there's not any set up there to have her confined to a small paddock.

I do have an option of taking her to a friend's barn that's about 2 hours away. They have a free paddock right now, with a shelter. The next paddock has 2 older gelding in it that never get taken out. The barn's owner is willing to use electric fencing to make the paddock smaller and more confining for my mare to heal. She could probably make it as small as 20 x 20ft or 20 x 30ft. My mare would be outside all the time on flat ground. Does this sound like a reasonable alternative to stall rest? I have a call into my vet, but I believe she was going on vacation this week, so I can't talk to her directly.

Thanks for any help you can give me. I've been stressing about this for a while and working on alternatives so my mare can heal.
Moderator:
DrO

Posted on Tuesday, Apr 12, 2005 - 9:42 am:

Hello Heidi,
Sorry to hear about the troubles. Concerning further diagnosis and treatment, we can't be sure that something will not turn up that might do better with some other therapy but 90% of the time if rest and antiinflammatories don't fix it little else will. Not knowing the nature of the injury I cannot say if stall rest would be required but with the scenrio you present it sounds like small paddock rest might be best. With the gait you describe I am also concerned about acetabular fractures (the socket of the hip) as part of the rule outs. Did anyone do a rectal: you can feel other fractures of the pelvic bones though you can't rule-in SI luxations with it. Did you see the article, Equine Diseases » Lameness » Diseases of the Spine, Back & Pelvis » Lower Back Pain in Horses where we discuss SI luxation in detail?
DrO
Member:
Heidih

Posted on Tuesday, Apr 12, 2005 - 1:19 pm:

DrO,

Thanks for the information. I did read the the article you list and was mildly surprised to find that accupuncture can work in this area.

A rectal palpation was not done initially. The lameness vet would like to do one, but she'd like me to bring her into the clinic where they have a stocks. My mare was pretty unhappy with having her tail and hind end messed with and the vet felt like she'd like some additional restraint available. When she returns from vacation I'll set up an appointment.

I haven't had either vet talk about a hip fracture. Is that a condition that can be diagnosed with a portable x-ray, or is it one that needs a more powerful unit? I have the option of taking her to a clinic that's about 1 1/2 hours away that has the more powerful (digital) x-ray unit and an MRI. That clinic has 2 vets that are lameness specialists.

It's hard when we don't have very many specialists in the area, nor do we have any clinics close that are set up for surgery or heavy duty dianostic work. Univ. of IL and Univ. of WI are the 2 closest large animal teaching hospitals, and if I have to choose, I'll probably go to Univ. of WI because then I won't have to haul a trailer through Chicago traffic.
Moderator:
DrO

Posted on Tuesday, Apr 12, 2005 - 11:25 pm:

Careful Heidi, look carefully at the signalment for acupuncture: undiagnosed back pain unresponsive to other therapy. These are probably chronic muscle injuries with problems of spasm. If your case is truly a si subluxation I would not look to acupuncture for help.
DrO
Member:
Heidih

Posted on Wednesday, Apr 20, 2005 - 8:21 pm:

Hi again Dr. O,

I was able to have my mare reexamined on Monday evening. The vet did a rectal exam. She doesn't feel any crepidus in the pelvis. She doesn't believe theare any fractures. She did say that she could have a hairline fracture, but that it wasn't likely.

When palpating the SI area, externally, she did feel some heat. She really feels that the injury is in this area.

I asked her about a fracture in the hip area, she said that based on her exam and where the mare reacted to her manipulations, as well as the heat she was feeling in the SI area, really kind of ruled out the injury being in the hip.

She is still pushing for a nuclear scintigraphy (sp?) scan. Right now that is out of the picture, financially. We were able to compromise on the small paddock (20 x 20 ft) turnout with anti-inflammatory treatment. She'll be getting 1g of bute daily for 30 days and then be re-evaluated. If after 90 days she's not showing improvement, I'll take her up to the U of WI in Madison for the scan.

Does this sound like a reasonable course of action? I think we'd both like to stall rest this mare, but with her personality it's just not feasable.

Thanks

Heidi
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