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  Discussion on Conservative care of older wobbler
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New Member:
hanovera

Posted on Monday, May 18, 2009 - 4:13 pm:

I want to share some experiences and invite comments/suggestions.
My 21 yr. old Hanoverian became dramatically uncoordinated and lethargic about a month ago and have had 3 vet opinons. Glad I discovered (belatedly) this web site because it has lots of great info. 1st vet did physical exam, thought it was clearly neurological, and considered: EPM, Herpes IV and spinal trauma caused by either injury or arthritis. EPM blood test was negative we didn't have to go for the more difficult spinal tap (which you'd still need if the blood test was positive, meaning only that he'd been exposed. Herpes Iv was unlikely since neither he nor horses he'd been around had snotty noses and fevers and it's rare in our area. His past history also suggested possible spinal damage/nerve impingement, as follows:
I got him "cheap" (for a Hanoverian) at age 13 after he'd been put out to pasture due to owner lack of interest and possibly, we thought later, a suspected back problem. He had nice gaits and a nice disposition for a horse who hadn't been ridden in 6 mos. and I had some experience with reconditioned senior horses so I got him anyway. Indeed, he started off with no muscle tone, stumbled a lot, bucked upon canter departs, was very girthy, etc. but over time, he improved greatly. The program was gradually increased riding (from 20 min. walk trot at first) to, by a year or so later, training level and then 1st level dressage, plus 1 hour or less trail rides up to once a week. He even did light jump lessons (low crossrails). Other than a slight but persistent weakness in the left hind, and a stiff neck, both of which seemed to explain his reluctance to bend to the right in trot or canter. Also he was able to stop bucking upon canter depart but it was always very difficult to get him round and stop throwing himself along in canter using his neck as a lever. (Now in retrospect I've learned that that's physically the only way he could comfortably canter). Maybe we could have suspected there was a strong physical cause, not JUST rider tension, lack of submission, and mild arthritis. Anyway, he did improve greatly with this light work but just couldn't go over into ease of performance. Personallly I think the improved muscle tone gave him more years of life up until this point last april when he totally fell apart. His left hind had gotten way more noticeably weak last fall; I had him on much lighter work; and then when I started to try to ride him more "dressage"-ly he became in a week, totally uncoordinated and lethargic as described above, a really dramatic change
It's not that common a problem and vets don't see a ton of this, apparently. 1st vet like I said thought neurological but a 2nd opinion thought no, it was a hip or pelvic injury. 3rd vet was a highly respected orthopedic surgeon from WSU and said just on physical exam that he's positive it's neurological and only question you'd reveal in radiographs & myelograms would be which vertebrae etc. though he suspected high in the neck (he saw front end incoordination as well which was more subtle). Anyway, based on his history of hind limb weakness (though subtle till now) and neck stiffness, he thinks it's probably progressive osteoarthritis causing a nerve impingement though past injury could also have been involved. It either just came to a head over time or he had a recent injury that tweaked it worse.
I decided not to get radiographs at this time since they all agreed that, if I was ruling out surgury, it wouldn't help me treat him any differently than I'm treating him now which is rest and antiinflammatories, basically. I decided not to go for surgury due to $$ and the fact that it only has about 50% success rate, in much younger horses, etc. etc. and he's 21.
Another remaining question was, stall rest versus turnout. Let him roll, or don't let him roll. I chose turnout on a more or less flat pasture part time with flat dirt paddock the rest. The grass helps protect his gut from the gram and half of bute a day (we tried more or less bute, and also banamine but it does seem to help a little to have some daily dose. I let him roll which he does often. He even has good days where he will GALLOP down the fenceline trying to race the younger horses and yes he might trip and hurt himself bad one of these days but I'd rather see him enjoying some sunset years (or days or weeks because apparently there's no way to know which day he'll be down and unable to get up and have to be euthanized).
The only other treatment was intravenous DMSO during that 1st week but it didn't seem to help. Also he's on 5000 units Vitamin E per day (scavenges free radicals for inflammation) and the same joint supplement he's always been on which has glucosamine/chonDrOitin/msm/HA.
Amazingly, my farrier said she knew of a wobbler who recovered after 2 months at pasture but vets say there is likely no hope of much improvement. Vets, and an equine massage therapist, also say chiropractic is downright dangerous for a neurological case, so I've avoided that though lots of wannabe helpful bystanders are pushing it.
I just wanted to share these experiences and say, great article on this Wobbler/CSM subject by your vets in this web site. The only other really thorough one I found is called equine wobblers.com Any other thoughts or suggestions on "senior" wobblers is welcome.
Moderator:
DrO

Posted on Tuesday, May 19, 2009 - 9:56 am:

Welcome SusaninWA,
Note that the CSF tap does not clear up the issue of exposure vs diseased spinal cord either, see EPM article for more on this.

I do agree with the assessment that if this is late onset cervical vertebral stenosis secondary to degenerative changes conservative treatment as you have outlined is logical. I also like the decision to allow pasture rest until the horse becomes obviously uncomfortable or dangerous to himself and handlers then consider euthanasia.
DrO
Member:
astbury

Posted on Tuesday, May 19, 2009 - 10:20 am:

Susan - I hope your horse enjoys his "sunset" time - and continues to play with his younger friends when he feels up to it. I'm sure he wouldn't want you to wrap him in cotton wool - I know from personal experience that it's very hard when your old friend shows signs like this and the worry is never far away - but you obviously care greatly about him and however long or short his time is with you, I am sure he feels secure that you will help him when he needs it.
Member:
ekaufman

Posted on Tuesday, May 19, 2009 - 9:54 pm:

Hi Susan,

Glad your old man can be a horse for his retirement. I had an old TB with a similar diagnosis (severe neck arthritis with impingement). I maintained him happily for several years on prednisolone and turnout.

Just to keep in the back of your mind, mine didn't suffer a fall or debilitating degeneration but instead essentially lost his mind and began savaging a pasturemate. I was lucky enough to be there and dragged him out of the pasture and euthanized him. He was extremely neurologic by then. That type of aggression is, so I'm told, very rare but not unheard-of with spinal damage. (It was so weird we checked for rabies, although we don't have rabies in horses yet in CO.)
New Member:
hanovera

Posted on Wednesday, May 20, 2009 - 3:06 pm:

Elk's story is an interesting cautionary. I have heard prednisone can make both people and animals crazy and irritable, however. But I will keep my eyes open (he's starting to share the pasture with a pal now).
Member:
tamarag

Posted on Wednesday, May 20, 2009 - 5:49 pm:

I take prednisone for my Lupus when I get into a major flare up or sick. It is the only time you don't want to make me mad. Watch out, what ever is in my hand will probably get thrown your directions.

It is a terrible drug, but a very useful one also.

Good luck with your old man, I hope he is peaceful in the time he has left.
Moderator:
DrO

Posted on Wednesday, May 20, 2009 - 10:15 pm:

susaninWA, the chief emotion folks report feeling when taking glucocorticoids, like prednisolone and dexamethasone, is a mild sense of euphoria...and hungry. These are the same steroids the body releases to help with stress. Having given thousands of steroid injections and oral prescriptions I cannot remember anyone reporting much in the way of behavioral changes except an increase appetite.
DrO
Member:
tamarag

Posted on Thursday, May 21, 2009 - 12:06 am:

Dr O

I find that strange. We had our Aussie on it for a skin condition. We had to take him off it, because he became so aggressive also.

With in a week or so of being off the drug, we had the same sweet dog back, just with a terrible itch.

When I go on it, the first 2-3 days I feel like I have been hit by a train, then the pain calms down. I wish I had could feel euphoria on it.

Everyone in my Lupus support group will tell you the same thing. Now I will totally agree with the appetite. I went from 112 to 170 when I was very very ill with the Lupus in full swing.
Moderator:
DrO

Posted on Thursday, May 21, 2009 - 9:01 am:

Hello Tami,
I have less experience with immune suppressive dosages as you would take in the case of Lupus, which are ten times higher than that used in anti-inflammatory cases. And I have very little experience with humans taking I.S. dosages. I know in humans that some sites report mood swings as a human side effect and even rarely psychosis, but everyone I have ever known taking steroids reports either no change in mood to the more commonly reported side effect of mild euphoria. If we are going to use individual stories as evidence I would note I have severe allergies to poison ivy and a mild allergic response to yeast products. So occasionally I find I have to be on steroids for short periods. I don't feel anything on them.

However let's get back to horses. I probably use immune suppressive dosages (ten times higher than the one susaninWA would be using) once or twice a year without seeing aggression, maybe 40 times over my career without remembering a single case of behavior associated problems. I use antiinflammatory dosages every week sometimes several times a week and usually the prescriptions is from 3 days to 3 months long. Over 20 years that leads to well over 10,000 administrations of a glucocorticoid to a horse. I don't remember a single behavioral problem related to it's use. It is my experience this should not be a consideration for treatment of susaninWA when trying to decide whether to treat her horse for a serious life threatening disease like she describes.
DrO
Member:
ekaufman

Posted on Thursday, May 21, 2009 - 9:35 am:

If we're all testifying, I should say that everyone involved attributed my gelding's sudden aggression to degeneration in the spinal cord and a rapid spike in pain. The prednisolone significantly improved his stability, mobility and comfort for several years, and a little extra appetite was a good thing on a hard-keeping old OTTB.

I mentioned the prednisolone because I believe it significantly lengthened and improved his retirement.
New Member:
hanovera

Posted on Thursday, May 21, 2009 - 5:13 pm:

elk, I thought about that later and it wasn't very sensitive of me to say as I am not a vet and i really don't know anything about prednisone other than heresay, and here I am complaining about bystanders opinions! anyway, I bet the pain and degeneration is the main cause of the crabbiness. That might explain my old boss with the back problem. . .
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