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  Discussion on Horse Uncooperative for Nerve Blocks - Any Suggestions?
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Member:
Skeller

Posted on Friday, Jun 10, 2005 - 2:47 pm:

I need some help figuring out some options for diagnosing lameness on an uncooperative horse.
Right now we are only working on the front end (thank goodness). He is lame on both legs, but it initially started in the LF (he has arthritis in the knee). I suggested to the owner that she really need to have the vet do a full lameness examine which is how I ended up holding the foot so to speak. (and I’m probably on the black list of my vet now to). It sure looks like there’s something else going on now. He’s limping on both but seems to switch back and forth. He’s almost sound on 1 gm Bute 2x day but not ridden. He had an muscular Adequan injection for the Arthritis 2 months ago.

The vet was trying to do nerve blocks starting at the fetlock to see if we could localize the majority of the pain. However we were only able to do one, the outer RF fetlock. When we attempted to do the inner block he became VERY uncooperative, i.e. extremely light in the front end. We quit when he started trying to strike with the free front foot.

We tried several things, Put half cup blinders on him, (lip twitch doesn’t work, he goes up), neck twitch (learned a new technique). The vet also gave him a small amount of Ace but this didn’t have any affect (it’s not very affective at other times with this horse i.e. teeth floating either. He appears to be sedated and then snaps out of it as soon as you start the procedure. And of course you couldn’t give him much and still conduct a viable lameness exam).

I know the real problem is that this horse needs to go back to manners 101. He’s 18 and has some history issues, and his owners overlook his pushiness (They aren’t doing him any favors, I’m discussing this with them tonight, however my advice might not be welcome). He’s ok to work around until you try to do something out of the ordinary (clipping, teeth floating, sheath cleaning, anything with needles). Ok with shoeing but not the best. He has a real issue with males, but this lady vet has gotten along with him in the past.

Without the blocks, it really makes things a guessing game for the vet. She is coming back this weekend to do x-rays which he had been ok with before. The other options of ultrasound or thermograph haven’t been discussed but I was wondering if that would be a good next step and provide enough info without the blocks. We would really like to determine if he might be navicular.

Just wish he would let us help him, but if he won’t, I’m not sure what we can do besides keep him on NSAIDs and joint supplements.

Suggestions on ways to proceed are appreciated.
Member:
Nisquy

Posted on Friday, Jun 10, 2005 - 5:47 pm:

My horse injured her right hind and my vet knew she wouldn't cooperate for the blocks, but wanted to do one in the area he felt the problem was coming from, so he sedated her (I think with Dormosedan but I'm not positive) did the block, and then gave a shot that reversed the sedation. She was awake and flying around in a couple of minutes, totally sound. Luckily we only had to do the one block to confirm the area of injury.
Moderator:
DrO

Posted on Saturday, Jun 11, 2005 - 10:54 am:

It all depends Skeller on the significance of the findings. A obviously hot and painful area should not need blocking to make the diagnosis. Blocking is used when significant findings on the PE are not found.

There are many possibilities Buffy. If he used Dormosedan (detomidine) he probably used either yohimbine (I have used but the reversal was not complete but we were able to continue the exam with difficulty) or more effective would be atipamezole, a drug I have not used yet. I would love to know the drugs and dosages that produced such a good response in your horse Buffy.
DrO
Member:
Nisquy

Posted on Saturday, Jun 11, 2005 - 7:31 pm:

Dr.O:

I will try to find out the name of the drug for you. My vet did explain the whole process at the time, and also said the name, but I immediately forgot it! If I don't talk to him sooner, I will be taking Buffy for her next shockwave treatment in two weeks, and will ask him then. It was pretty amazing!

Bonny and Buffy
Member:
Skeller

Posted on Sunday, Jun 12, 2005 - 4:56 am:

Thanks Dr. O and Buffy.
One of the big problems is that there is not an obviously hot and painful area to the touch. He does allow you to flex his front legs (as long as there aren't any needles around.) One of the reasons for the block is to see if there was possibly something going on in the hoof. While it is bi-lateral in the front, it doesn't really seem navicular. More obvious on the left and he definitely shifts from one to the other as described in your article. (We were wondering about navicular but the horses I'm familiar with also worked out of some of the soreness). He has always short strided on one front leg also so it makes things even more difficult to see. The vet took some more xrays yesterday (some specific for navicular) but is looking pretty hard at the tendons. There is scarring of the legs that indicates this horse has been pinfired and blistered at some time in his life. Thanks for the input.
Sandi
Moderator:
DrO

Posted on Sunday, Jun 12, 2005 - 9:08 am:

Skeller, in our article on navicular synDrOmes we have stress tests that may help localize the problem to this area.
DrO
Member:
Skeller

Posted on Wednesday, Jun 15, 2005 - 12:10 pm:

Thanks Dr. O. That was helpful.
Member:
Skeller

Posted on Sunday, Jun 19, 2005 - 10:08 am:

The article on Navicular really helped. Especially since the vet ruled navicular out based only on the radiographs. Can a horse be navicular if they have a normal looking navicular bone?
Despite "normal" xrays, this horse exhibits many of the typical signs. After trimming long toes he was much better. Lameness on one leg going one way and switching to the other going the second way. Head bob in turns. MUCH better on 1gm bute a day.
The vet did not do the frog test or any of the others described for navicular, just the xrays. Unfortunately I read the article after the visit.

I worked with several horses in college about 20 years ago (yikes that seems a long time ago) who were VERY navicular. Came out of their stall looking decrepit but very quickly worked out of the soreness. Is this typical of navicular? They were all kept on low doses of bute. I was wondering because this horse doesn't seem to work out of any of the soreness however that was when his toes were very long. He was overdue for being trimmed.
Thanks, Sandi
Moderator:
DrO

Posted on Sunday, Jun 19, 2005 - 9:03 pm:

As the article explains there are many diseases that actually fall under this heading so there is no typical case and we really need to move away from this idea of "navicular". Your findings will depend on the specific disease you have, addressing your specific questions:
  • Yes some forms do have clean navicular radiographs and this is a good prognostic sign
  • Yes some forms of navicular do improve as they warm up and it is a sign that that should not be stalled as long as they are.

You really need a good set of nerve blocks to first determine the location.
DrO
Member:
Skeller

Posted on Sunday, Jun 19, 2005 - 11:08 pm:

I agree with the nerve blocks. Unfortunately I don't think the vet is willing to try again. Maybe in a week or two Buffy will find out what reversal drug her vet used.
Thanks for all the responses. I know it's best not to post about someone else's horse, but since I recommended they do a lameness exam and also help take care of him I appreciate the information.
Sandi
Member:
Gavet

Posted on Friday, Jun 24, 2005 - 7:08 am:

Your vet may want to consider Sedivet as a mild sedative that should not interfere with lameness examination.
Xylazine has best been reversed with tolazoline (in my hands).
Good luck with pursuing diagnostics!
Member:
Nisquy

Posted on Friday, Jun 24, 2005 - 5:43 pm:

Hi! Sorry about the delay. We went today for Buffy's third (and YAAAA final) shockwave treatment and I asked my vet about the drugs used for her block on the RH tendon sheath area. He said he used Xylazine (sp?) and then Yohimbine (40-50 mg.?) for the reversal. Bonny and Buffy
Moderator:
DrO

Posted on Sunday, Jun 26, 2005 - 9:57 am:

Thanks for the update Buffy. Let me remind everyone that xylazine can cause a rapid violent kick sometimes when the hind leg is unexpectedly touched.
DrO
Member:
Skeller

Posted on Sunday, Jun 26, 2005 - 10:39 am:

Thanks for the info Jennifer, Buffy and Dr. O. We'll see where everyone is willing to go from here.
Sandi
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