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

Don't even consider adding Se to the diet without knowing if your hay is deficient in it. That's a whole nother can of worms.

When you had a hay analysis done, what did you test for? Can you post the results?

If she was my horse, I'd contact Dr. Valentine and ask if the head tilting is stemming from EPSM , if she has ever seen it. If yes, I would not postpone the proper diet. Period. It can take up to six months until the effect of the diet is visible.
I would not give her bute until I'd have a definite diagnosis on her neck.
Take everything with a grain of salt, I said "if she was my horse". But she has had enough stuff done to her which wasn't necessary at all and didn't heal anything either.
If my horse was diagnosed with EPSM, I'd have it on the proper diet and 24/7 turnout within hours. I would not experiment with any symptom treatments until I was sure the diet is fully working.
This is due to the fact that, in my 45 years with horses, I've seen my share of clueless vets who, and that's the bad part, are not capable of admitting that they're clueless.

I would hope that once I change the diet it won't take six months to see improvement considering she has already been on the basic EPSM diet, just not to the extent she needs to me. I have a hard time telling myself that I should wait months and months to see if the diet works while my horse continues to have such consistent symptoms. Since it seems that any effects that come from upping her fat intake will not be immediate then I will begin adding fat now and give the bute. If she stops head tilting while on bute and then begins again when off it we know it is not diet related. If it doesn't get any better we can cross some things off the list all together and wait for changes via the diet and/or do head/neck x-rays.
I have talked to Dr. Valentine about the head tilting and she said if it is there even when the horse is getting the proper diet then look elsewhere. She did not say she has seen it before.
I don't think that the internal blisters where unnecessary seeing as the UPF has decreased by at least 60%. That has to count for something. Though her stifles may be entirely related to ESPM, I think it is likely that she just has UPF and EPSM doesn't help her situation. We can only wait and see.
I have SUCH a hard time with vets. I have worked with 5 or 6 and they all have strengths and weaknesses. I don't trust any of them entirely nor do I have the money to drive long distances and pay for a specialist. I appreciate the advice given. I have tried my best and though the treatment route I chose could have been different at least I did something for my horse. When I bought her as a yearling I was 17 years old. I've done the best I can in the 5 and a half years I've owned her and have yet to find one person I can trust with horse advice- that's why I ask everyone.

As far as the hay analysis I tried to post it here and it says the file is too big. I'll have to work on that. I had a basic analysis done and checked for sugar, starch, WSC, ECS, NFC, etc. Unfortunately it appears Selenium is not listed. Guess I'll have to run another test.

I understand completely what you're saying. Im in no way criticizing you. You did way more than a lot of owners would do. I basically said the same thing as Dr.V
Oh, and it COULD take up to 6 months, but it doesn't HAVE to. Oldhorselady here is already seeing results after what, a week or so.

Do you know where your hay is grown? If so you can ask the grower or the county extension office if there is a selenium deficiency. They can also tell you if Se should be supplemented.

I'm sorry I can't offer any advice . I just wanted to say I think it is great but you are working so hard to try to help your horse

Deserthorsewoman: I hope that it doesn't take 6 months- I am hopeful for visible changes in a month if we get lucky!

Lightning: Thank you for your support. It has been rough, but I have a responsibility to my horse to put in the effort. It will be a shame if I am not able to ride without back problems and end up selling her after going through all of this, but regardless I want her to be happy and healthy.

I told Oldhorselady to videotape progress. Every month, so she can compare.
I'd suggest the same to you. Sometimes, if you see your horse every day, you won't notice changes. The video will show it. Just tape at the same place, the same activity

Where she is at receiving 10% of her calories from fat, she is not "training" the muscles to use the fat as an energy source. You have just been feeding her extra calories. Until you get her up to the desired 20-25% fat, the muscles are going to use glycogen as it's main energy.

You will see improvements quickly (if diet is going to help). Typically you will have measurable changes by the end of the first month. It will take a few months to plateau. That will be as good as you get just by diet.

I have been trying to forever to get an account set up on here to post on your thread!! I found it while recently googling head tilting. Look into Temporohyoid Osteoarthropathy. My mare was just diagnosed with it after acouple months of showing a head tilt that progressively got worse. Has to be diagnosed with a scope into the guttural pouch. We are currently treating her with 30 days of antibiotics & bute. If no change or her condition worsens we will have to discuss surgery. There isnt alot known of this condition as far as what causes it. I am currently still researching personal experiences myself. It can either be caused by a guttural pouch infection/inner ear infection (which is what we're hoping) or that the joint is fusing from normal wear & tear. If it is fusing, once fused mobility will be limited and eventually the horse will get a pressure fracture just from going about it's normal every day functions. When it fractures is when surgery will have to be done to remove a bone in the joint. Google it for best explanations.

Here is a video of my mare prior to diagnoses. We just got her diagnosed Saturday so in about 2 weeks I will do an updated video


Best of Luck!