Stifle Inflammation and Neck Arthritis

Because Leo's stadium performance at Fair Hill was uncharacteristically poor, I wanted to confirm there was nothing physical going on. Recently, a boarder's eventer was diagnosed with a suspensory lesion, which requires an 18-month recovery period, after being not quite right for several weeks. Needless to say, I'm becoming quite paranoid about Leo and Leo's legs now. Leo's vet, Liz, came out this morning to look him over.

We discussed what was going on:

• Leo's been on and off his feed for a couple of weeks; this has happened before. I assumed it was just grass-related this time
• Leo has gotten fussier than usual with the bridle in the last week
• At Fair Hill, he was struggling with the deeper distances, he wasn't leaving the ground well and was jumping over his shoulder in the air. All of which wasn't normal for him. 
• Right lead canter is still especially difficult for him and Sally thought something physical was inhibiting him

Liz evaluated his back and sides; he was particularly sensitive at his girth area, right behind his elbow and as always was sore across his back. She said this indicated he had ulcers. She palpated his stifles and he was reactive on the left. She flex tested his hind legs and jogged him.  He was off on the left hind; not something I would have noticed except that he didn't jog off straight or in balance. He seemed better to the right. We put him on the lunge so Liz could evaluate how he was moving and she said he wasn't using his left hind properly and his movement indicated a stifle issue. Interestingly, he has always dragged his left hind leg a bit and doesn't always get a good push off that leg.


Her preliminary diagnosis:

• Ulcers - which were causing the back soreness, and then the back soreness was putting strain on his hind legs
• Left Stifle inflammation - there was something causing pain in his left stifle which was preventing him from using that leg properly. The left hind is used more in the right lead canter, Leo's difficult side, both from a canter depart perspective as well as maintaining the quality of canter

Stifle Ultrasound

I spent the morning talking to my insurance adjustor and then Liz and Cooper came back in the afternoon to do the ultrasound on his stifle. I felt bad for my fellow boarders because everyone who saw the 2 vet trucks outside the barn thought that something really bad had happened! Needless to say, Leo had quite the pit crew today. 

I always get a little nervous when we do a diagnostic on Leo. Liz always reminds me he raced for 3 years and horses get a lot of wear and tear on the track, but Leo always surprises us. The ultrasound showed a little bit of inflammation in his left stifle, but confirmed there were no ligament or tendon injuries. All the bones and cartilage looked good as well. Cooper did a quick scan of his right stifle to confirm it didn't need an injection. It didn't. He was able to do a side-by-side comparison of the left and right stifle to illustrate the degree of inflammation. Ultrasounds certainly are educational!  

Neck Arthritis in horses, really? 

THEN we ultrasounded Leo's neck. Liz and I had been talking about Leo's neck for a while. Back in March when we were having hoof issues, I started asking her about it because I was hearing more and more about horses whose lameness was ultimately caused by arthritis in the neck (like Boyd Martin's Neville). Even Sally said she was recently teaching Courtney Cooper and one of her sale horses had a lameness they couldn't find the source of - until they ultrasounded the neck! 

Leo locks his neck near the base, right in front of the withers, and has a really difficult time bending to the right, stretching, and just in general obtaining any consistent acceptance of the bridle. He also hates having his neck fussed with, whether you are grooming him or pulling his mane. Since the ultrasound machine was out and I was filing all these claims anyways, I figured why not figure out what's going on in his neck. 

Cooper started with his right side, starting at the C7/C6 vertebrae and worked his way up the neck. That all looked fine. Then he moved to the left side. Sure enough at C5 and C6, there was a large bone spur which Cooper explained would be the reason he has such a hard time bending to the right. He's probably had this spur the entire time I've had him. Cooper also ultrasounded his poll. There, the ligament on the right side was enlarged - I think because Leo over flexes because he can't bend probably. Cooper wants to address the arthritis first and see if that helps the poll. If not, they would do shockwave therapy on the poll ligaments. 

Cooper explained that neck issues are more common than you realize in performance horses. He said upper level dressage horses have lots of neck problems as do steeplechase horses who are likely to experience falls in their careers. Flat racers can have neck problems simply because of how they are ridden at the track.  

Final Diagnosis:

• Ulcers: Leo will be on GastroGard for 30 days
• Stifle: Left hind will need to be injected to combat the current inflammation
• Neck: Left C5 and C6 vertebrae will need to be injected (likely on a regularly basis to keep Leo comfortable)

It's crazy how careful you have to be with horses. It would have been so easy just to push onto the next competition without consulting the vet since Leo wasn't lame under saddle, but he would be uncomfortable and likely wouldn't put in a good performance. I asked Cooper what caused the stifle inflammation and he said its simply a result of being a performance sport horse. It's going to happen from time to time and need management.   

I've never leveraged a vet in the past as much as I do now, but I've also never worked with vets that I considered to be sports medicine doctors. Even in human medicine, doctors have different focuses and specialties. Orthopedic doctors follow different methodologies and have a different set of experience if they are dealing with athletes versus desk-jockeys who don't make a living using their bodies. I learned this when I broke my leg. The first doctor put my leg in an external fixator which puts you out of commission for months. The second doctor, sports-oriented, put a metal rod in my leg. I was walking within days. 

I'm not 100% sure why the ulcers are popping up now. Leo is always kind of on edge, so he could produce his own stress or it could just be from being back in more serious work the past 2 months (after having most of the winter off). The GastroGard should fix him up though.