Ask the Vet: Emergency Care

Question: I have a 12-year-old Quarter horse gelding that I have had since he was 2. At 4-years-old, I began training him for barrels, which he did quite well. He was very flexible and had excellent turns. However,  around the age of 7 and 8 his performance declined. He began to turn stiff and very moody when ridden. The last couple years he began to cringe when I cinched him, walking stiff and wild eyed and waiting to set back. This occurred even after a month layoff. The things we have done from day one when the problems began consisted of, hocks injects, changed pads, girths and saddles. We contacted a chiropractor in which they adjusted the hips. The chiropractor even said his neck was out along with his sternum, which he continued to adjust monthly.

The muscles on his underline will get hard and you can press and he begins to move. This never gets better even after layoff or an examination from the veterinarian or chiropractor. We are at our wits in. When I ride him he feels off and I can’t pinpoint where. Please help he is a sweet horse and is too nice to retire. I would really like to find the problem.

Answer: Sorry to hear about your horse’s problem. He sounds like a nice horse and you and he have been together for a decade. These type of longstanding problems are a challenge to diagnose.The clinical signs that you have described can be caused by many disorders. Muscle metabolism disorders, genetic disease, occult lameness and gastric ulcers are just some of the problems that come to mind.

Does he have any of the Impressive bloodline? If he does, has he or his parents been tested for the hyper kalemic periodic paralysis (HYPP) gene? If he is negative for HYPP I would begin by doing a basic blood panel paying close attention to muscle enzymes creatinine kinase (CK), aspartate aminotransferase (AST) and electrolytes. If these enzymes and electrolytes are within the normal range, the blood chemistries should be repeated after exercise. If they are still within the normal range, it is unlikely that the horse is tying up. If the enzymes are significantly elevated, he may be having episodes of exertional rhabdomyolisis or “tying-up” syndrome. Rhabdomyolysis can be genetic or diet related. Deficiencies of vitamin E and/or selenium can cause this syndrome and can be diagnosed with a blood test. If your horse has genetic predisposition to tying up the diagnosis can only be made by muscle biopsy. Treatment of these conditions is done through dietary therapy.

If the muscle enzyme tests are negative, a careful lameness exam would be a good next step. This exam should involve watching the horse go in hand, on the lunge line in both directions and possibly under saddle. A hoof tester exam should be done on all four hooves along with fetlock, carpal (knee) and hock flexions. If any lameness is noted diagnostic analgesia, nerve blocks, can be done. If the lameness can be localized with the nerve blocks, radiographs and /or ultrasound exams are warranted. If no lameness is noted on exam nerve block of both front feet may be done to conclusively rule out laminitis. If theses tests do not localize a painful area, referral for advanced diagnostic techniques may be needed.

Dr Bertone’s work a few years ago showed that horses with gastric ulcers can have a multitude of clinical signs. After ruling out other sources of pain ulcers should be considered. I prefer to examine the stomach with an endoscope. However, there are fecal occult blood tests that have been shown to be useful in diagnosing gastric ulcers.

Rib fractures, vertebral fractures, arthritis of the vertebral facets and sternal fractures are also disorders that could cause the signs you are seeing. Contact your veterinarian and discuss a diagnostic plan that you are comfortable with. Once you have a diagnosis, you can then proceed with treatment and hopefully get you and your horse working together again.