PSSM/head tilting/hind end lameness- Help me solve this!

I guess that's what we're all doing, throwing ideas out there, in hopes of hitting the bull's eye....

Im still stuck on the nutritional aspect. The UFP symptoms are EPSM symptoms, and since hocks and stifles were clear, and treatment didn't
really do anything long-term.

She was in dressage training, which is pretty demanding energy wise, so she could have had not enough of any of the key components.

Kudos to your mare for the heart and try she seems to have. She's obviously in a lot of discomfort while you lunge her but she's still trying.

As far as the high fat diet, you are nowhere near providing enough fat in the diet if the Envision is the sole fat source. The .52# of fat in the Envision (if she gets 2# per day) provides 2 Mcals. The other stuff in the Envision is about 1 Mcal. If she gets 20# of alfalfa pellets and hay, that's about another 18 Mcals. The fat portion will only represent 9.5% (2:21) of the diet. That needs to be more than doubled. Her hindend muscles are starved for energy. Cheapest place to start.

Have you done any acupuncture on her? Anything neurological in origin could benefit from acupuncture. It is late in the game if she has been doing this from a young age but it's still a cheaper alternative to some of the things you've thrown out. I would do a minimum of 3 treatments (2-3 week intervals).

Starline stables: I have not done any other IV/IM joint supplements. She does have a fly mask with ears, but I have a hard time thinking its the head shaking syndrome because it it no consistent enough- only when lunging, not when ridden and not when turned out (other than when she runs around like an idiot). I hope she does not continue this behavior out of habit. Knowing her personality I don't think she would. As far as training I will have to try and find a knowledgeable rider that can come rider her when I am unable to. I can't afford training at the moment and have already borrowed 8,000 for the dressage training and owe another 7,000- dang ponies are so expensive!

Existentialpony: I have also thought it could be a balance or vestibular problem and have considered looking into that, but I can't decide if I should put that at the top or bottom of my diagnostics to try list. I have not checked her eyes. She will do the head tilt straight, but not as much. She seems worried at the canter undersaddle and she used to seem worried at the canter on the lunge so it has made me wonder if she feels unbalanced. She had multiple neuro exams when we were in the process of diagnosing the EPSM and the last one was pretty normal but that doesn't mean she couldn't have a minor vestibular issue- thanks for the idea!

Deserthorsewoman: I was a little unclear with my phrasing- she gets 2 pounds of envision classic a day, which I was told by the grain rep that that was equal to 1 pound of fat a day. BUT reviewing Dr. Valentine's calculations she would need 4 pounds of Envision to get one pound of fat a day. I FEEL HORRIBLE that this was not caught earlier I couldn't sleep last night because of it. Apparently the vet I had at the time didn't catch it either. There is no way I can afford to pay 30 dollars a week for a fat supplement so I will be adding the other half a pound of fat through oil. This mistake has now changed my mind about UPF treatment. We need to wait until she has been on the proper fat before jumping into surgery.

Left Hand Percherons: Thank you for the compliment- Harmony is SUCH a sweet and good worker and it has been so hard to see her personality fade because of her discomfort. See my comment to deserthorsewoman about diet issues. I have not done acupuncture, but I have someone that could do it. I will speak with that vet when she comes out next week.

Current plan: Fix the fat issue ASAP, talk with farrier (first week of April) about squaring her toes as much as possible, have her blood drawn next week to check electrolyte levels- if there is an issue I would like to try the Equiwinner electrolyte patches. Thank you everyone for the ideas. I don't know if I will be able to forgive myself for the fat miscalculation, but I will keep moving forward and doing everything I can to help this poor girl. I've had her since she was one and she is very important to me.

I hope so much that I can be glad to have been so persistent with the nutritional issue.....
With squaring the toe I WOULD WAIT also. It helps a lot with true UFP, but I don't think it is it. Rather the muscle issue.

To me this screams misalignment. I would say that she is misaligned C!/C2/C3 this in turn will have put her wrong down through her body.

I would like to know what the chiro did and thought when they saw her.

Would it be possible to see pictures of her standing square, taken from behind, and, standing on something tallish from above and also of her stood square, of her knees up to her chest.

I hope she gets to feeling better!

Foxhunter: I could get some pictures, but it will be the weekend before I can do so, I am finishing up midterms this week. She has been seen by 2 different chiros. Her atlas has been out of alignment twice (end of the summer and fall), but they past two times she was adjusted/checked her neck was not out of alignment and her lateral flexion was fantastic. I will work on getting some pictures this weekend.

Wausuaw: Thank you!

Ok,
I have figured out the necessary changes for Harmony's diet. The downside: It will cost $275 a month for her vitamin/mineral supplement, pelleted fat supplement, alfalfa pellets, MSM and joint supplement.
I have not even figured the cost of her needing 1 cup of oil a day.
Plus I have to factor in 50-60 dollars a month in hay.

How much do other people pay for EPSM diets? This is insane and I don't know how my parents or I can afford it. We will have to, but seriously- we are talking $4500 a year to FEED my horse.

While the pelleted fat supplements are great, the cheapest route to fat supplementation is bulk vegetable oil from Sam's or Walmart. Get the big 5gal bottle and put a 1 ounce pump on it.

I don't know how you're figuring your costs but if you were to provide all the fat calories with oils, that would run you less than $1/day. I'd rethink everything else and up the hay. It's the cheapest part of the diet.