One of the reasons I decided to take TC down to my somewhat local vet clinic to get injections was so that I could get another set of eyes on him/his x-rays. And, of course, to get the injections done in a more sterile environment. It gets windy at the ranch so I wanted to make sure that we didn't unintentionally introduce anything else into his joints.
I've known this vet for a while, he was the vet who helped with Rico's internal pigeon fever years ago. He was happy to hear that Rico was being a loon the other day! The trees were being trimmed (far from where he lived) and he was galloping around the pasture bucking. Then he would canter over to TC (who was trying to be a good companion and standing by the fence) and he'd bite his face, then run off again.
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| TC says "where are we???" |
Soon after we arrived, poor TC got yet another lameness exam, which was great! Although the more vets that say "hey this horse is actually pretty sound" the more I feel insane. But he did have this amazing app that evaluates lameness based off of video (I was going to ask what it was and then decided not to because I don't think that's good for my mental health) and it did note that he was weaker in the left hind x right front diagonal pair. And on a tight circle on hard ground, they could make him the tiniest bit lame on the right front. That tracks with everything we've seen so far.
He then did a neuro exam, which I was a little surprised by, but ended up being a good thing. They went in tight circles and halted and walked up and down hills. By that point, TC was having kind of a good time, he was shockingly good for the tech who was working with him. Normally he's trying to be a clown. Don't worry, he got plenty of clown time while we were in the clinic, he found a resident who thought he was very cute and was barging around touching all the equipment to make her laugh.
After the exam, I got to show the vet the slough of x-rays that TC had had in the past two months. He spent quite a while going over them with me, which was SUPER helpful. So far only OG vet had seen all of the rads, as I just sent the hoof ones to my local vet.
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| Then he realized where we were |
These were the notes I took from the x-rays and the lameness exam:
- TC is weaker on LH x RF diagonal, LH does not want to reach as far forward, RF is more hesitant.
- TC is very slightly neurological, he's a little too comfortable standing off balance (doesn't correct himself) and when going downhill, seemed to struggle to figure out where his RF was - he reached a bit too much. Very mild, not unsafe, thought it could very easily be his size + muscle weakness rather than an actual neurological issue.
- His feet do look like they have improved, vet agreed with my OG vet who thought his feet were pretty bad in early Sept, agrees with my local vet that his feet are better now (not perfect), agrees with my farrier that it will take time to continue to improve. Wants more heel and thinks that the pads he has on and the trim that my farrier is doing will get us there. But he also said that there's only so much you can do sometimes.
- His hocks and pasterns weren't as bad as my local vet thought they were. Said the same thing as OG vet - that he has shockingly clean joints for this large of a horse at 14yo. But he was happy to inject them to help him out, but suggested injecting hocks, coffins, and just the RF pastern joint. The LF seemed okay and given that he came up more off on the RF, he figured we could do that one first.
- His neck might be a problem. Saw the C6/7 rotation, but also an anomaly in C6 where one of his transverse processes seems to be shorter/smaller than the other (can't tell which one due to it being an x-ray). This can cause issues in the soft tissue nearby. Also saw some narrowing in the joint at C6/7 but no remodeling, suggesting that if it is his neck, it's at least not a severe case because it hasn't caused remodeling.
The conclusion on the neck stuff was this: I am well within reason to chase down his neck with a CT scan to look for pinched nerves. This would easily explain all the issues I've had with TC, such as balking and muscle wasting. However, this involves general anesthesia and would just be to get a diagnosis. The vets these days are seeing more and more of this and new treatments are being developed, but it would be a long road ahead potentially requiring surgery. There's no major reason to go that route immediately given that he's pretty sound and isn't showing more than extremely mild neuro symptoms. The vet suggested instead that we could inject C6/7 on both sides and maybe also C5/6. If he DOES have neck issues and he just needs neck injections to remedy them, that'd be great!
So, we discussed the injections quite a lot, both limb and neck. In the end, I decided to just do his limbs at this appointment with Alpha 2. Two spots each in his hocks, both front coffin joints, and the one pastern joint on his RF. There is still enough leftover where we could do his neck at a later date. And I'll tell you why.
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| Sleepy boy, he snored quite a lot |
The reason why I decided to do it this way is that I could see two realities...
1. TC has a neck issue. There are nerves being pinched and it's causing him enough pain where he's unable to use himself properly and slams on the brakes frequently when he feels unbalanced or when he feels the pain. He's more forward in the winter just due to the cooler weather and maybe the softer ground helps too. Treatment is potentially just neck injections, possibly surgery, or it could mean that he should be retired (at least from dressage, if not full retirement).
2. TC's neck is fine, all of this has just been a combination of everything creating a vicious cycle starting with his feet. His feet started to get uncomfortable, so he braced in his neck and back, dropped through his thoracic sling, and then couldn't move forward. This caused the balking behavior and because he wasn't using himself properly, the muscle wasting. The neuro stuff we saw at the appointment was a red herring because he's just too weak to properly support himself right now. Treatment is to fix his feet and do some injections to make him feel better in the meantime so that I can bring him back to work.
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| Getting his feets all cleaned up |
I've been very careful with this process to not do too much at once. We started with the diagnosis, moved onto his feet, then nutrition, then bodywork, and now injections. It's been really nice to see what is helping - for example, he does seem more comfortable after his feet, which I wouldn't have known if I'd done the injections before fixing his feet. Same thing with bodywork, I noticed a difference in his posture afterwards so I feel confident continuing.
So at this appointment, if I were to inject both the neck and the limbs, I'd not be able to rule out either of them.
For that reason, we decided to start with just his limbs and save the rest for his neck later on. I asked the vet how long I should wait to see an effect. He said well, if TC were lame, it'd be pretty immediate - within five days of the injection he'll be feeling better. But I'm looking at behavior that has been reinforced for years and I'm also looking at his topline to grow, which takes time and consistency. Although I do hope when I bring him out on Sunday (which is when we can start back to work), he drags me all over the arena because he's so forward and happy that his joints feel better.
We agreed on at least two months to slowly bring him back (further) into work before I make the decision on whether to bring him down for neck injections. And looking at the calendar, I'm on vacation for the last half of January, so we'd actually be looking at more like three months. I'd likely make the decision before my vacation and then make the appointment for after my vacation. I'd rather not inject his neck and then leave the country just in case there were complications.
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I hopped on him with his cavesson and surcingle on in order to warm up the other day - used the kids' reins! |
So we did the limb injections and TC is resting unhappily at home because he's locked on his paddock to rest and because it's supposed to rain today. He hates it, he probably thinks this is some horrible reality show that he's been put on to get in shape and lose weight (he's down 67lbs! From 1457 to 1390), like the biggest loser for horses without the abuse, although he'd like to speak with the producers.
Meanwhile, I'm trying not to be too concerned. I had thought that we'd ruled out his neck... but I also couldn't believe that it wasn't his neck. But also every vet on the planet is obsessed with necks right now, so is this like when you buy a new car and see that car everywhere? He has full range of motion with his neck and is never careful about shoving his face into all sorts of places, but he also does struggle with steering/the connection in a way that suggests neck. But he's also a friesian and they seem to be born with extra stretchy ligaments.
I think I've already decided that if it is his neck, I'm not interested in going to the extremes - I won't put him under anesthesia. But I will inject it, as much as I'm hoping it isn't his neck at all, and that these injections we just did fixed it all, I am kind of glad that we have at least one more option to try later.