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

19K views 49 replies 13 participants last post by  Swany530 
#1 ·
Hello,
I have a horse with lots of issues and need all the help I can get in figuring this out. I have worked with lots of vets and every time we solve one issue another comes up. I will try to sum things up for the sake of time. If you need more details on something mentioned just ask.

I have a 6 year old Belgian Warmblood mare (not draft cross) who was diagnosed in the fall of 2011 via muscle biopsy with type 1 mild PSSM/EPSM. She has been on a low starch and high fat diet since then. muscle tone is now normal. She has always had stifle issues, but in the past 6-8 months the below issues developed.
Prior to this diagnosis she was tested for EPM with blood work and spinal tap but was negative. Her neuro exam was normal once she developed normal muscling via PSSM diet. overall she is not the most balanced or coordinated horse- has always had issues with staying relaxed and balanced when cantered under saddle.

Current issues:
Head tilting and sometimes shaking worse when going to the left, not present at walk, bad at trot and worse at canter. Not seen while under saddle- only when lunging or free lunging without or without any tack on. Sometimes seen in turn out or similar stretching/tilting while in cross ties. teeth are fine. I would see her head tilt like this as a baby once in a blue moon but now its every time we work. (see video)
Hock lameness- tested positive in flexion tests for both hocks, right was worse. Had both injected 2 weeks ago. improved in terms of more flexion and hind end power, but not sure if they worked entirely.
Stifles: Intermediate UFP, worse with right stifle. Had internal blister done 5 weeks ago, helped a lot but still have some issues. (has full turn out in dry lots) Had 2 blisters done as a 2 year old but the effect wore off. Now considering surgical method.
Occasional muscle soreness in hind end/glutes
Out of alignment- atlas and or sacrum have been an issue.

Other issues:
high head set at canter
resistance to pick up canter, worse to the left
swapping back leads
dropping out of canter
lack of power in canter
bunny hops with both back legs sometimes when cantering fast
canter never looks effortless for her, she prefers to trot
kicking out when asked to pick up the canter on the lunge line
sour mood- seems like she is always uncomfortable in some way, but is such a willing horse she will work under saddle well because she knows she is expected to behave.

Chiro helped at first and now doesn't. Head tilting developed when she came home from 4 hr. a week dressage training (was in training for 8 months). Symptoms list above became noticeable at a show 1 week prior to her leaving training. She is lunged way more at home due to my back issues- i cant ride as frequently. I'm sure this hasn't helped her joints but I have to keep her moving somehow because of the PSSM.

That is as brief as I can be. ANY advice is helpful. I have seen multiple threads online about horses that are almost identical to mine in terms of hock and stifle issues/lameness, PSSM or suspected PSSM, back/hind end soreness, sacrum alignment issues, etc. Somebody help me fix my horse- I can't stand to see her uncomfortable. I am now considering nerve blocks or investigating the head tilting as a separate issue than the hind end lameness (vestibular, balance/neuro issue, maybe do an MRI or scope her pouches?) We are also considering surgical splitting of stifle ligament (not cutting it entirely). Another note: she had xrays of her hocks and stifles 2 years ago and they were perfectly fine.
 
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#27 ·
So, for the OP, what's eating up, literally, the most money are the two feeds....not the supplements.
I'd start with more, better hay, more or less free choice, weigh how much she actually consumes. Calculate calories the hay provides, and the difference between need and provided by hay is made up of fat or high in fat feeds, with alfalfa pellets as carrier . Add vit/min, the joint Supp and MSM. Done.
 
#28 ·
Thanks for all of the information guys.

Could the following vitamin and mineral supplement work for Harmony? It is not listed on Dr. V's list, but I don't see why it wouldn't work. When compared to Purina's WellSolve L/S it is only 1-2% higher in sugar/starch so it is still in the acceptable range as I understand.

Purina Horse Feeds - NATURE'S ESSENTIALS

Could someone clarify if she would be getting enough/too much selenium if she got 2-2.5 pounds of this feed? (I need to pull out the hay analysis for you guys as well.)
I would feed this and then all fat via oil mixed with alfalfa pellets.
My hay is very high quality 60/40 alfalfa grass mix and Harmony gets about 17-20 pounds a day, more if she appears to need it. She weighs just under 1200 pounds. I cannot feed free choice hay because her companion is a pony and he would explode!:lol: Plus, usually if I increase her hay she gains weight so if I went free choice I am assuming she would keep gaining. Her muscle tone is normal- even if she is having issues due to a lack of fat, she does not need to gain a lot of muscle mass like the concern expressed when switching a horse to the EPSM diet for the first time.
 
#31 ·
Churumbeque: OH MY!! I hope it didn't appear as though I don't feed hay! The list of feeds you quoted are what she gets as "grain" but she eats 18-20 pounds of 60/40 alfalfa grass mixed hay. I am not a fan of feeding grain actually, I prefer hay and pasture and only give concentrated vitamin and mineral supplements to make sure they don't have any gaps in their nutrition. The pelleted alfalfa was just used in her diet for taste because she doesn't like to eat her other supplements plain. Sorry for the confusion!

I have worked with the only semi-local chiropractors in the area- I'd have to travel an hour or more to use anyone else. I will try getting her to "lift her spine"- I have seen this done before.
 
#32 ·
Have you considered slowfeeder haynets?
Slow Feeding Horses on Paddock Paradise Tracks - Paddock Paradise Wiki

That way she can eat little, but all the time, and pony also.
Those feeders/nets do amazing things....my horses never run out of hay, but consumption is down 40%...blimp horse lost weight, hardkeeper gained. And they're happy.

Re the vit/min....check on Purina Enrich or other ration balancers ...gives you all necessary nutrients, a bit mass compared to a 2oz supplement, for adding the oil.
For selenium, I'd see what your hay provides, and would add extra, above of what the vit/min or Rationbalancer provides only if hay is severely deficient.
 
#34 ·
$50.00 a month was just my guess.
I pay $5.00 a bale and they weigh on average 50 pounds each.
I just took 18 pounds (average daily feeding) x 30 days = 540 pounds of hay a month divided by 50 (weight per bale) which equals 10.8 bales a month. So 11 bales a month times $5 a bale gave me about $55 a month for her. Of course I'm sure it varies a decent amount so it's probably closer to your cost since I don't weigh every feeding.
 
#37 ·
deserthorsewoman: I didn't quite understand your comment about the Purina product. Could you explain what you meant?
"Re the vit/min....check on Purina Enrich or other ration balancers ...gives you all necessary nutrients, a bit mass compared to a 2oz supplement, for adding the oil."

I have considered the slow net feeders and I would like to get one or two. I am debating where to put it and which type- some of the reviews were bad so I need to find a well constructed one. WAY more natural for them! :D Downside: our hay is in very tight flakes so that would involve lots of hand pulling apart and fluffing. If I can get my parents to do that I would like to switch (Horses live on my parents farm- I don't feed).

Oldhorselady: I agree that grain is ok if it benefits the horse. I used to feed a lot of it previously. Can I ask is your horse on the TC Senior because she/he needs a senior supplement, for weight gain, for adding fat to the EPSM diet? I'm assuming it is a little bit of each of those. I considered feeding Purina WellSolve L/S, but it says she needs 10 pounds to get all vitamin/mineral and its $30 a bag. The way I understood it is that this feed is designed to provide vitamins/minerals like a RB, but because of the bulk of roughage in it you get more calories and can feed less hay. If this is the only advantage (for my horse) then I would rather just feed the Enrich 12 RB. I am definitely open to adding grain at some point if she needs it or I want to feed less hay.
Also, is the Vitamin E in your grain/RB low and that's why you have a Vitamin E supplement?

Left Hand Percherons:
I agree Progressive is overpriced, at least for a horse like mine it doesn't work well. I don't understand the rep's idea of more amino acids either. He has seen the hay analysis so his recommendation doesn't make sense. Plus, doesn't doubling the RB cause you to over feed vitamins and minerals? Obviously feeding varies by weight, but I was under the impression that 1 pound was sufficient for 1000-1100 pounds.
You are right about the muscle building- I didn't phrase that correctly.

Thanks for your help everybody!
P.S. As if I'm not busy enough figuring out all of these issues, Harmony went and gashed her head open today! :shock: We are going to get stitches this afternoon. What a little booger!:wink:
 
#38 · (Edited)
I wasn't sure if you were familiar with ration balancers. From what I hear the Enrich is quite good. Since you feed at least a pound, it gives you "mass" to pour the oil over. A vitamin/mineral supplement, given by the ounce, wouldn't be enough to suck up the oil:)

Slowfeeder: tight flakes are no problem as long as the feeder "gives". Netting does that, metal grates not. For ease of filling for your parents, I would suggest the Nibble Nets, hung high enough so she can't get a foot in ( if shod. If barefoot, it's no problem). For further ease for your parents I would get big nibblenets who have enough space for two days worth of hay:)

ETA: for gashes on the head....bubble wrap....;-)
 
#40 ·
Update

Ok, I wanted to give a more complete update on my plan.

Yesterday, when Harmony had to go the vet for minor cut (not my normal vet, but one who has seen her once) we talked a lot about her head tilting. I have really been working to see what is causing it and he said since I already blistered her stifles, injected her hocks and tried chiro adjustments that he would like me to try something less invasive. We will be giving Harmony a low dose of bute for 3 weeks to see if that has any affect on the head tilting and then report back to him. This means unfortunately that for the next 3 weeks we will not be upping her fat intake because we need to be able to distinguish what helps her. I am not very happy about this, but I think we need to proceed.
After the 3 weeks, her fat will be upped to the one pound a day. Then we can judge if that fat increase works miracles in itself. Do you guys have a guess as to how long it would take to see positive changes from increasing the fat? When I begin increasing fat (and assuming my vet analyzes my hay and supports the decision) I would like to stop feeding a ration balancer. (I posted a thread about this in horse nutrition) This being said I would like to feed this supplement:
E-Se-Mag - Horse Antioxidant Supplements from SmartPak Equine

Eventually I would like to try the Equiwinner electrolyte patches to see if that helps anything. I am debating having my vet draw blood to check electrolyte levels next Tuesday.

I will get those pictures for you guys this weekend of Harmony's spine. I know postponing the diet change isn't the best idea, but trying the 3 weeks of bute will allow us to then further investigate the head tilting and have some direction. I will not be working her anymore than I have to during this time since the fat won't be increased.
 
#42 ·
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.
 
#43 ·
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.
 
#44 ·
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.
 
#45 ·
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.
 
#47 ·
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.
 
#49 ·
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.
 
#50 ·
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!
 
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