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  Discussion on Ultrasound guided Cortisone injection for CSM
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Member:
justy

Posted on Saturday, Jan 22, 2011 - 8:38 pm:

Our 7yr old Hanavarian gelding will be going to UC Davis for cervical xrays to confirm or rule out CSM.

Depending on the findings, one of the possible therapies that may be considered is ultrasound guided injection of an anti inflammatory (either cortisone or hylaronic acid)

This would be done for primarily pallative reasons, but am wondering if anyone has had this procedure done to their horse and what kind of response ie: percentage of improvement and duration of improvement you might have experienced.

Thank you,
Debra
New Member:
ches

Posted on Saturday, Jan 29, 2011 - 3:33 pm:

Hello Debra

I saw your message and wondered how your gelding got on at the vets?
I was on this site to get some advice myself on the same subject, although I'm a little further along in the process than you.
My 13 year old gelding (trakehner x TB( was diagnosed with neurological problems caused by arthritis in the base of his neck, last February (along with a stomach full of ulcers), although I pretty sure he'd had this for a long time and it had been misdiagnosed or attributed to his bone spavin. He had a cortisone injection into his neck and after a couple of months he felt really good - about 95% normal - (I was also having a cranial osteopath treat him regularly). On the whole we had a pretty good time from April through to late Autumn but unfortunately he started to get a bit wobbly again; swaying and stumbling a little, plus standing abnormally (although no where near as bad as he was the first time around). (I also found that his ulcers had returned). So he recently had another injection into his neck and we are trying to get on top of the ulcers again. I was disappointed that it was only just under a year between injections, although my vet seemed positive. You say this is for primarily pallative reasons? My main concern at the moment is that, despite my vet telling me to "crack on" after his first injection, am I actually helping or hindering him by continuing to work him. He is only in light work; hacks, a bit of flatwork (which of course is challenging as he's lost a lot of confidence) and occasional jumping on a good surface (which he loves so much). I have had him since he was 3 and love him dearly, I'm just really worried about how I manage him; I'm not sure if it would be better for him to be retired and reduce the speed of degeneration. My vet doesn't give much away just saying that as long as the injections don't need doing as frequently as every 6 months then just carry on - but is it really that simple? I hope your news was good.
Best wishes
Sharon
Member:
justy

Posted on Saturday, Jan 29, 2011 - 5:19 pm:

Hello Sharon,

Thank you for responding to my inquiry. We will be taking our boy to Davis on Wednesday for the x-rays and possible myelogram.

This has been a seven month process to rule out why he seemed to be struggling with something "not quite right." Last July we noticed he seemed a tad off two weeks before the Northern CA JR/Young Rider Championships. Nothing specific, but he would not seem consistent with his training workouts.. One day fabulous, the next day not quite... I had two veterinarians come out a couple of days before Championships to go over him with a fine tooth comb to make sure it was in his best interest to take him to the show. Nothing was found to the contrary and we had a fabulous three day show with my daughter and her horse winning the Second Level Championship with a score of 69.8%

Two weeks later, he stumbled during a test at a show and showed a slight short stride in the front. He was diagnosed with a hoof bruise and we were fine with giving him time off to decompress after a busy show season.

Since then, he has deteriorated markedly. He has been bodily ultrasounded extensively, all four feet x-rayed to look for hoof changes,hoof blocks, all four feet ultrasounded in water, massaged, rested,saddle checked, scoped for ulcers (Negative),and diet changed to eliminate sugars. All the while, he continued to show obscure lameness that couldn't be determined if it was front or hind. His back does not seem or react to soreness. In fact, my daughter rode him in a Cashel soft saddle for two months to rule out any saddle/back issue He starts out very stiff and choppy and sort of warms out of it, but now cannot hold a canter for more than a quarter of a 20 meter circle. Turning during serpentines is very difficult. Most alarming is the stumbling and unsureness of his gaits. He has fallen with my daughter twice in the last three months. He has always been a bit of a hind toe dragger, but it is more obvious now.

The neurologist noted several priprioceptal deficiencies.. Toe stabbing when going uphill, he made two mistakes during the circling tests and hovers his front leg when asked to cross a small trench.

He will be tested for EPM as well as the x-rays and possible myelogram.

I am so pleased that the cortisone injection worked well enough for you to enjoy your boy for almost a year. Since his second injection has he come back as far?

I am cautioned by the neuro vet that injections into the neck are not curative. They help decrease the inflammation which helps decrease the pain enabling them to move better, but eventually the underlying pathology, ie. nerve impingement, arthritis, or lesion continues its progressive path. We may have the injections done, but depending on what is found, our horse may have permanent neurological damage that may or may not allow him to be safely ridden, let alone continue to train and achieve the goals that he had potential to reach.

We also have had our boy since he was four and has been my daughter's dream horse after years of riding and showing other peoples horses. We are feeling a bit shell shocked, but very much appreciate your good wishes.

Will post more of the findings when we get them.

All the Best,
Debra
Member:
dres

Posted on Saturday, Jan 29, 2011 - 10:39 pm:

Just curious have you tested for selenium levels.. I live in NorCal too and have a friend that went thru H** and back with a horse stumbling etc to find out he was low in it.. Remember our hay is very low in selenium out here..
Good luck ..

On the first day God created horses, on the second day he painted them spots..
New Member:
ches

Posted on Sunday, Jan 30, 2011 - 5:14 am:

Hi Debra

It was good to hear from you - whilst I wish your horse was not having these problems, it is so good to talk to somebody else about it.
In answer to your question regarding how well Ches has done since his second injection, it did take a while to improve the first time (probably 6 weeks plus). My vet said that unlike humans, horses can remodel their spinal cords (he described it like an electrical cord where the plastic wears away and they can rebuild that plastic). He encouraged me to do things to get the horse to think about where he's putting his feet, like raised poles, to help this process. So, as he only had the injection 3 wks ago it's a bit early to say - he doesn't seem to be swaying as he moves off from a standstill or tripping as much. He has never fallen down like your chap but before his first injection he was doing the toe stabbing and was dramatically twisted to the right so that when you rode him or as he ran around the field his head was always to the right; in canter it was awful and he bunny hopped. The trot gait also went completely - he had this exaggerated movement in front where his legs hovered - and riding down hill was like riding two halves of two different horses stuck together. Looking back on this, the injections (and perhaps osteopathy - who knows?) really made a tremendous difference. Ches used to event (a little) but he's had high suspensory damage, OCD in the hocks, bone spavin and shows bony changes in the coffin joint, as well as all this, so I have no goals for him at all other than trying to keep him happy & healthy. Believe it or not, he is relatively low mileage and I have always tried to manage him carefully so who knows why this horse has had so many problems; I know he was shown as a youngster before I had him and sure he was overfed, also my osteopath says he has a kink just in front of his wither which he believes may have been there since birth and in his opinion caused much of the arthritis in his body. I will never know for sure...

Please do let me know how you get on - sounds like you are doing all the right things (we didn't have the myelogram just xrays and various neurological tests, like crossing the front feet and pulling the tail etc) but xrays showed the problem was in the neck not in the brain. There is a vet in the US that specialises in this area Dr Barrie Grant - he is open to hearing from vets or owners and you can contact him on barriegrant@equinewobblers.com, (I haven't contacted him yet but I might).

Best of luck
Sharon
email: sharon@thecollaborators.com
Member:
justy

Posted on Sunday, Jan 30, 2011 - 1:31 pm:

Hello Ann

We had a complete blood panel done six months ago and all came back within normal limits. He will have another blood panel drawn when we take him for the x-rays to have a comparison.

Our trainer, two veterinarians, myself and my daughter reviewed and analyzed the diet/supplement intake. Nothing raised any concerns in that department. He has not lost any weight and in spite of not getting worked in training mode, he has not lost any appreciable topline. My daughter rides him at least an hour a day even if it is just up and down a level road.

Sharon- it has been so helpful to have you respond to my inquiry. Having someone else to chat with has been appreciated. When you get the injections done, are they ultrasound guided to the vertebrae or are they given intramuscularly?

Rouge was brought here from Germany when he was three, so I have no idea what kind of nutrition and trauma he might have experienced coming here. He had not been very long under saddle when we got him and we do not utilize lunging or side reins in our training program hardly at all. He gets too wound up, so it is just easier to get on and ride him. He did pull back on the trailer a couple of years ago and broke a halter, so whose to know if that has caught up with him.

The most frustrating part of all of this is that there just has been no "AHA!!!!! moment. We have all been so baffled by this obscure lameness, stiffness, choppy gait, no suspension in the trot and inability to hold the canter.. It is good to get some kind of answer but this is definitely not the answer we were expecting to find.

I have heard of Dr Grant. I will talk to our neuro vet and see if she feels a consult with him might be a consideration.

Thanks so much... Will keep in touch,
Smiles,
Debra
Member:
justy

Posted on Monday, Feb 14, 2011 - 8:54 pm:

Latest update:
Trailered our boy to Davis for cervical x-rays. We were concerned that in the two weeks since the initial diagnosis of a nuerological involvement that he continued to show more deterioration even at the walk with more stumbling and stiffness.

Our nuero vet had a group of 3rd/4th year students and we volunteered Rouge to be a demo horse to review the process for testing for nuero deficits. To our dismay and the vets, it was obvious that our concern was not our imagination. I brought the video that I recorded from two weeks ago and even tho he was a bit amped at Davis, he was not at the same level of deficit that he was two weeks prior.

HIs cervical x-ray was picture textbook perfect. No arthritis, no bone overlay or remodeling, no subluxtions, no OCD, no slipped disks, and a spinal canal that "you could pass a garden hose thru" according to the vet. No stenosis, narrowing or crimping that could be noted

He had a complete blood panel taken as well as an EPM test. All blood work has come back normal. The EPM test came back a few days later as negative.

As a result of his decreased stability, the vet was very sorry to inform my daughter that her dream horse and riding partner was nuerologically unsound for riding.

We are scheduled to do a nuclear bone scan next Tuesday in the hopes of finding a "hot spot" somewhere on the vertebral column or back that could give a clue as to where the compression (or whatever the problem is) could be located. Unfortunately, it could be deep where the cervical vertebra are the most difficult if not impossible for x-rays to penetrate.

Depending on the results of the bone scan and how he handles the standing sedation, he will have a myelogram on Thursday to see if we can get an answer to this puzzle. The biggest worry and concern is how will he come out of the anesthesia and will he be able to get up. We have been thoroughly versed that we may have to make the decision to euthanize him if he cannot get up from the anesthesia.

I am heartsick.... I just don't know how to decide if I should let him go if they find something on the myelogram and he is still under anesthesia OR if he can get up without hurting himself, how long I should let him continue to progress (if he does- who knows?)

I consider myself a reasonable person. I was an OR RN for over 25 years and can be pretty realistic, but this is really hard to wrap my mind around the fact that this young, energetic, talented, lovely horse has some kind of equine MS.

Have I missed something?

Today I took him out for a walk and he was frisky, prancing and silly. But three days ago our trainer took him for a handwalk and he fell down to his knees just calmly walking down a level road. He can be wibbly wobbly front and back one day and solid as a rock another. Even if he was to be a pasture ornament, he cannot have a huge turnout because of the danger of running and falling. What kind of a life is that to be cooped up in a paddock and be worried that he might fall anytime?

I have had my 32 yr old pony euthanized and I have a 21 yr old T-bred, so am not a stranger to saying goodby to my sweet horses, but this one is throwing me for a loop, not only as a horse owner but also as a mom.

Any thoughts or suggestions would be appreciated

Thank you,
Debra
Member:
canter

Posted on Tuesday, Feb 15, 2011 - 7:09 am:

Debra, I wish I had a useful suggestion for you, but there's nothing I can offer beyond the excellent care you have given your horse. I hope the additional testing you have planned provides an answer - one that can be treated.

It must be very difficult to helplessly watch your beloved horse stumble and fall and wonder about his future; it must be infinitely worse knowing that despite your own hurting heart, you will need to find the strength to provide comfort to your daughter as well.

My very best wishes~
Member:
ajudson1

Posted on Tuesday, Feb 15, 2011 - 8:10 am:

(((Debra)))
Moderator:
DrO

Posted on Tuesday, Feb 15, 2011 - 8:28 am:

Debra, from a diagnostic stand point you seem to be doing all that is possible. When they do the myelogram are they also going to sample the CSF for analysis?
DrO
Member:
mrose

Posted on Tuesday, Feb 15, 2011 - 11:07 am:

What an ordeal Debra. My heart goes out to you and your daughter. I am confident that you will make the right decission after the myelogram is done. Whatever it is, you have certainly done your best.
Member:
frances

Posted on Tuesday, Feb 15, 2011 - 11:42 am:

I'm so sorry to hear this Debra, and really hope that a treatable cause for his disability will be found.

What a terrible situation to be in.
Member:
justy

Posted on Tuesday, Feb 15, 2011 - 12:04 pm:

Thank you all for your very kind words. I deeply appreciate the caring spirit and understanding of how difficult this situation is for my daughter and me.

I wanted to reach out thru this forum and tap the wealth of knowledge and experience that I know exists from all the members to re- assure my self that I haven't overlooked any consideration.

At some of my crazier moments, I would even consider a horse psychic or a voo doo dance to drive out the evil spirits if that would help heal this horse.

Dr O- I will ask your question when I see our nuero vet. I would presume so since we have access to the CFS. Certainly if he had reflected the antibodies for EPM we would have gotten a sample of CSF for definitive diagnosis.

I am just not understanding how my horse can be so affected by a compression problem when I make sure that the saddle fits, the nutrition is good ect and I see so many other folks just throw a saddle on regardless of fit, ride the horses without any kind of consideration and they seem to be just fine. I understand there is a dynamic component to this problem, but I just cannot visualize what is happening physically to the anatomy that is causing this loss of perception to his feet. I was watching a reining competition with these huge men on little quarter horses and wondering why don't these horses have a compression problem??

I am going thru some grief stages and I realize that life just sometimes hands you situations that is unfair and you learn to cope and deal with them.

I will keep you in the loop as next week progresses.. Thank you all again for your compassion and understanding

Debra
Member:
hpyhaulr

Posted on Tuesday, Feb 15, 2011 - 1:25 pm:

Debra,
I wish I had something more than a hug to send you.
When they analyze the CSF are they planning a tick serology as well? Can't be any crazier than a horse psychic (which I find totally reasonable right now). Hoping for serendipity.
New Member:
ches

Posted on Tuesday, Feb 15, 2011 - 1:37 pm:

Dear Debra

As you know I have a clear diagnosis of CSM and, so far, my boy has not got to the stage that your horse seems to be at, but I do live in constant fear that he has this all to come, so I understand your grief and feeling of helplessness. I wouldn't want to give you any false hope but the second cortisone injection does seemed to have helped my boy; maybe you'll know from the myleogram if this treatment is still worthy of consideration. I have given a lot of thought to what I might need to do in the future; I dread the day when the injections stop working and I see my horse really fall over. I would never want it to get to the point where he couldn't get up or even go outside and be a horse. I will keep my fingers crossed for you all next week - I really do feel for you and your daughter (the only consolation is that he doesn't have the same fears as you do). Sharon X
Member:
lilo

Posted on Tuesday, Feb 15, 2011 - 3:40 pm:

Sorry to hear about your horse's troubles, Debra. I have no advice, just one story. When my friend's home bred foal was diagnosed with Wobbler's synDrOme, she tried everything, but he can't be ridden safely. However, he has managed to live and thrive in her herd and even plays with his half brother at times.
Of course, this would not give your daughter her dream horse back.
It would be great if something came up that could actually be treated.
Lilo
Member:
justy

Posted on Wednesday, Feb 16, 2011 - 1:03 pm:

Good Morning,

Thanks to the three of you for your time and words of caring. I will bounce the tick titer idea to the vet.. I rescued my dog (now 12 1/2) and he had erlichiosis as a puppy. Rouge has been such a hot house flower that I can't remember ever taking a tick off of him but that doesn't mean we missed a few on the trail rides.

Sharon- your comment that he doesn't have the same fears as I do was comforting. He does live in the moment for his grooming, his peppermints, his connection with my daughter and me and his daily routine. I think he misses being ridden and going on adventures on the bridle path, but he sure enjoys his daily hour long grazing sessions!. We get him out several times a day and sometimes he needs a tablet of Ace to keep the ya-yas at bay.

My sincerest wish is that you and your boy enjoy comfort, companionship and a long time of mutual enjoyment. He sounds like a lucky fellow to have you for his person.

Trailering him to Davis is my next concern. There are two sides of a discussion... Wrap his legs, trailer him as usual in the straightload as he is use to with the padded sides, padded butt bar and padded chest bar. Don't tie his head and take my time and let him use the confinement as a way to orient him for balance and perception. I trailered him this way a couple of weeks ago and he did just fine and I never thought twice about it.

The other camp advocates take out all the dividers, throw in two bales of shavings for deep bedding, wrap his legs well, put on a head cap and let him be loose in the trailer. That way if he falls he wont' be caught under the dividers.

I can see both sides but I am really uncomfortable with the second suggestion. My daughter and I both feel that he would get pretty agitated if we just turned him loose in the trailer and sense the chances of him going down as he tries to figure out his balance in a completely new situation is greater.

I really liked it better when I didn't have to think about such things.....
New Member:
ches

Posted on Wednesday, Feb 16, 2011 - 2:42 pm:

Thank you Debra. Re: your latest concern, I don't know exactly how much worse he's got in the couple of weeks but if it worked then perhaps it's best to keep to the routine he is used to? Like me, you're obviously a thinking person which can be good but boy do we suffer for it!

I know you don't know what you are going to find out and I'm a bit hesitant to give you yet more to think about but something that I maybe didn't tell you before is that at the same time as Ches had his first injection, I also started using a cranial osteopath. Who knows what-did-what but as the results were so good I keep using him (both me and my partner use him now too!). Just a thought but perhaps you could get somebody out to him just to put their hands on, if you haven't tried this already.

Thinking of you,
Sharon
Moderator:
DrO

Posted on Thursday, Feb 17, 2011 - 7:55 pm:

As to transportation, it is as you say: all suggestions are fraught with danger. However if I had a horse fall in a trailer I would prefer as few obstructions in the way as possible. As to the compression, these are not issues of the rider causing problems but inherent instabilities in the spinal cord of the horse.
DrO
Member:
justy

Posted on Friday, Feb 25, 2011 - 12:37 pm:

Hello All,

An update to share: The nuclear bone scan performed on our LaRouge showed a very major " flare" and uptake on the faucets of the C7 vertebra. This was both a relief and a troubling find because up till then regular lateral xrays were not showing any thing abnormal. We did not do a myelogram based on these results.

Our nuero vet then had a series of oblique x-rays taken from behind/above the shoulder. These xrays revealed a malformed cervical vertebra that had major abnormal bone overgrowth with lysis and remodeling consistent on both left and right vertebra with more on the left. The xrays also showed a wedge shaped piece of remodeled bone that was impinging on the spinal cord. The opinion of the radiologists, nuero vets and consulting surgeons that were called to look at these views all agreed that this was the reason our boy was showing the mystery lameness and subsequent nuero deficits that had been such a mystery to us for the last 9 months.

We considered our options, but it was agreed that the continuing bone remodeling was not going to stop and neither was the pain that he was enduring from the bone wedge pressing on and pinching his spinal cord.

We made the compassionate choice to euthanize our sweet boy and yesterday morning he was gently, calmly and with both of us kneeling by his side whispering how much we loved him, let him go to a place free of pain and confinement.

Our neuro vet called us later that evening to share with us the news that the necropsy exam showed that the cervical vertebra actually looked worse on exam than what the x rays revealed. The bone was a gray color with pockmarks as well as the layers of bone remodeling that left the edges of the vertebra sharp and ridged instead of smooth and rounded. The wedge of bone that was impinging on his cord was fairly substantial and she can only imagine the pain that he was in as this had encroached over time.

It is her opinion that this was a process that had been in place before we bought him three years ago and we will never know why this very aggressive form of arthritis evolved. It brought us a tremendous amount of peace to know that we had made the right decision and that all of our searching for an answer had been revealed. The injections would not have helped at all, the bone was too damaged to be a candidate for cervical fusion, and the option to let him be a pasture horse would have prolonged his pain and could have created a dangerous situation for him and a handler in case he had fallen and could not get up.

It was my suggestion that we see if the nuclear scan would be a bridge between the xrays and the myelogram. She was open to it and she said she will now suggest and utilize this diagnostic tool in future cases. For our part, cervical xrays and a complete neurological exam by a nuero specialist will always be part of the pre purchase exam for any other horse we welcome into our family.

It is amazing to me how this horse performed these last three years.. He loved to show and put his all out there with my daughter as his partner. We have a wall full of show memories and blue ribbons. They were first level Champions for Jrs at Pebble Beach when he was six years old and were 2nd level Jr Champions at the California JR/YR Championship this past August with a median score of 70%. She was his trainer and his best friend. She also turned 20 two days ago. He would have been 8 years old in April. Who knows what might have been? It was her decision to let him go because she could not bear to know he was in pain. All the staff was touched by her composure, grace and concern for her horse in spite of her personal heartbreak.

Thank you all for your kind words and thoughts. It was helpful to hear from this forum as we made our way these last few weeks.

Debra
New Member:
ches

Posted on Friday, Feb 25, 2011 - 1:04 pm:

Dear Debra

I've just got your update and had to reply. Your daughter obviously gets her composure and grace from her mother; you have both been so brave.

I want to ask you more about the types of examinations you went through to understand better, but now is not the time. You have very evidently done the right thing and I hope that you find peace, as he has done. With all his bad luck, what a very lucky boy he was to have you both as his owners.

A big hug to both of you, take care.
Sharon x
Member:
canter

Posted on Friday, Feb 25, 2011 - 5:10 pm:

Debra,

I am very, very sorry to hear such sad news. It is clear, given the final diagnosis and then the necropsy,that you did the right thing. And it is clear to me that you have brought up a wonderful, compassionate and totally selfless young woman. I am sure you knew that already, but this sad episode certainly reflects what a wonderful Mom you are to have raised such an amazing kid.

My deepest condolences to you both.
Fran
Member:
lilo

Posted on Friday, Feb 25, 2011 - 5:51 pm:

My sincere condolences to you and your daughter, Debra. What a sad outcome, but you know you made the right decision for your beloved horse.
Lilo
Member:
dres

Posted on Friday, Feb 25, 2011 - 6:27 pm:

{{{{{{ HUGS}}}}}}

On the first day God created horses, on the second day he painted them with spots..
Member:
shirl

Posted on Friday, Feb 25, 2011 - 6:41 pm:

I'm so sorry for your loss.

Shirley
Member:
sross

Posted on Friday, Feb 25, 2011 - 7:39 pm:

What a blessing that the necropsy confirmed that you made the right decision.
Member:
mdelton

Posted on Friday, Feb 25, 2011 - 10:17 pm:

Debra,

I just read your update and am so sorry to hear the result. You did the very best you could do for your horse and made the right decision for him, yourself and your daughter. It is so hard to say goodbye to these wonderful creatures.

Mary
Member:
frances

Posted on Saturday, Feb 26, 2011 - 10:51 am:

I too am deeply sorry to hear this news. But what a good thing it is that you persevered in your search to discover the cause of his suffering, and so could bring it to a merciful end.
Member:
vickiann

Posted on Saturday, Feb 26, 2011 - 6:06 pm:

I am so sorry that there was no cure to be found for this wonderful horse in spite of so much effort on his behalf.

You took such loving care of him and in the end you gave him another wonderful gift. I hope that you and your daughter will find solace in his peaceful and merciful release.
Moderator:
DrO

Posted on Saturday, Feb 26, 2011 - 8:46 pm:

My condolences Debra. Finding a definitive cause and prognosis makes these decisions easier if no less painful.
DrO
Member:
justy

Posted on Monday, Feb 28, 2011 - 10:46 pm:

Thank you all for your kind words of condolence and sympathy. I am touched by your compassion and understanding of our loss. We miss him so much... Rachael and I went to the barn yesterday and brought home a multitude of flowers, cards, pictures and artifacts that were left at an impromptu memorial in front of his stall.

If any of you subscribe to The Chronicle of the Horse magazine, she and LaRouge are featured in the August 27, 2010 issue on pg 32. We also just learned that she and Rouge will be awarded the High point Jr. 1st level award, the Jr. 2nd level high point award and the overall high point award for 2010 at the Chapter CDS awards dinner next weekend. I hope I am cried out by then.

To Sharon- Please feel free to ask any questions that you wish.. I am more than willing to answer questions that anyone may have. My learning curve has been pretty steep these last few months and I have always appreciated the knowledge and lessons that so many other members of this forum have so selflessly shared. I would like to be able to contribute in any way I can.

We had spinal fluid taken for testing and blood taken for DNA to enable Dr Finno, who is pursuing her doctorate in degenerative neurological disease of equines, to add to her studies and data. We also gave our permission for Rouge to be used as a cadaver horse for the veterinary students.

I have a whole new level of understanding of how a neurological work up can be helpful in cases where the standard lameness diagnostics are unable to resolve "mystery lameness". I had four very well known veterinarians examine my horse, including one from Belgium who was one of the vets for an Olympic team in Europe. We had every diagnostic lameness test done you can think of including ultrasound on all fours done twice! Not one vet- as well as the massage therapist, acupuncturist, farrier, saddle fitter or gastroenterology team suggested that perhaps we might consider a neurology consult. It wasn't until he fell down the second time that our trainer, happened to run into Dr Finno at another barn and described Rouge to her did the idea even come up.

Please understand I am not trying to lay blame on anyone.. This was a difficult case to try to figure out and even if we had been clairvoyant enough to get a neuro consult four months ago, I think the outcome would have been the same. It is an area that has been off of my radar for all my horse years and now it will be part of my education arsenal to draw upon in the future.
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