Thursday, June 27, 2019

Liam's Final Chapter

Today, I had my sweet, bright, alert and enthusiastic 2 year old euthanized.

The cute snoot

OSU diagnosed Liam with wobblers. They rated him a 4/5 on the neurological scale, which also made him ineligible for the ultra expensive basket surgery that attempts to correct wobblers. Surgery will generally downgrade horses by one grade, two grades if they're lucky. Surgery is therefore only done on horses who are grade 1 or 2, SOMETIMES 3. At 4, Liam was a non-surgical candidate. Grade 1 is sometimes rideable, grade 2 is sometimes pasture sound.

After a baseline neuro test that showed he struggled to control his hind end and triggered some struggle with his front, we moved on to neck radiographs.


The radiographs painted a very bleak picture. Liam's neck was still growing since the growth plates are still open in the vertebrae (and at 2, they should be). The C1 to C3 looked good, with normal joint spaces and what appears to be plenty of room for the spinal column to pass through. The joint space between C4/C5 was a little cloudy and ill-defined, indicating some arthritis. The joint space between C5/C6 and C6/C7 were both very cloudy and barely defined, indicating severe arthritis.

Normal growth plate, MSD, SD, and the unlabeled green ovals are joint spaces.
The C4/C5 space is a little cloudy. C5/C6 is pretty cloudy, and the C6/C7 has a very occluded edges.
Not pictured, C7/T1. Rood and Riddle also suspected severe arthritis in that joint as it was just as occluded as C6/C7.

A secondary problem in the C7 vertebrae was a narrowing of the spinal column space (minimal sagittal diameter-MSD below) in relation to the sagittal diameter (SD below). The C7 should be the widest channel of all the cervical vertebrae. The ratio of MSD:SD should be 50% for C2-C6, and closer to 60% for C7. Not only does his C7 narrow, it was the lowest percentage of the 6 at 51%.


The neck presented solid enough evidence, that when combined with his in hand neuro tests, the vets were confident that his spinal cord was being compressed somewhere in the neck, most likely near the base, but it cannot be determined from only x-rays. X-rays only paint a single cross section of the horse, meaning, while it appears the C7 spinal cord channel has gotten shorter in height, it could also be wider than the other vertebrae, which would not cause compression. Sadly, x-rays cannot be shot from above. I could opt to take him to Rood and Riddle, who would do a CT scan of majority of his neck. It would go up to the shoulders, which are simply too big to fit in the machine, so we may not even see the C7 in the scan. The other option was a myelogram.

Myelograms are highly invasive procedures where the horse is put under general anesthesia and a spinal tap is done at the cranium. Special dye is injected into the spinal column and the horse's neck is extended and flexed, and x-rays are taken as it progresses down the spinal column to see where the dye stops (which indicates compression). It is a relatively traumatic procedure for the spinal column and can result in seizures and a temporary increase in neurological issues after the horse wakes up.

Here is a great link to the myelogram procedure.

The day I officially signed papers and paid for him 

Reasons to do a myelogram: confirm exact locations of compression for surgery, confirm compression for insurance purposes, confirm for a personal need to know.

None of those reasons apply to Liam. He's not a surgical candidate even if we could find it. I didn't get insurance set up on him yet so they have no say (I'm sure that would be audited and questioned, oh geez... 2 months in and a major claim on a fairly clear PPE? FRAUD). Finally, I personally do not need to know more beyond 'in the neck somewhere'. My need to know does not out weigh the suffering he would go through waking up. The vets warned me he would probably be grade 5/5 coming out of a myelogram and would probably need a sling to stand up and stay standing.

Beefcake! His shoulders really grew at the end of May- his topline was much more level in June than in this pic from April.

The vets did put out another offer: they can do the myelogram and just not wake him up... euthanize him on the table so to speak.

I didn't think the cost of doing a myelogram justified my need to know. I spoke with event trainer, who whole heartedly agreed we don't need to know.

Liam wasn't sure he needed to know about this ball.

So instead, Liam spent several more days at OSU with several gallon size bags of horse cookies (no lie, I left 4 gallon bags of treats and 2lb of carrots), and a note that said "Please feed me LOTS of treats. I also enjoy neck scratches."  I had to go home and work several days, but then I went back Wednesday to spend time with him, and today followed the shipper back to event trainer's farm. The vets gave him a bunch of anti-inflammatories to help him be more stable for the trip home, and he arrived without a scratch. The vet met us there, and he was humanely euthanized this afternoon, happy in the sun and eating grass.

Handsome boy

Sometimes you can try "stunting" the growth of a young horse with mild wobblers and pristine neck rads, and try to get them to grow out of it. The advanced level of his neck arthritis made this option a non-option.

Sometimes high doses of vitamin e also alleviate the inflammation in the spinal column. Natural Vitamin E (d-alpha, not dl-alpha) crosses the blood/brain barrier quite easily making it an excellent anti-inflammatory for the spinal cord. Therapeutic doses for this are 10,000 IU a day. We were already doing that.

The vet said we could reasonably give him anti-inflammatories for the next 3 weeks and keep him on stall rest to see if he got better and by how much. This didn't have a good feel for me, he could hurt himself at any time. This option just prolonged the inevitable with possibility of disaster.

He took his napping VERY seriously. He would lay flat out for an hour at least once a day.
He scared his vet tech the day before he came home- he was down flat out in the stall and twitching all over. I told his vet upon his arrival that he does do this daily, and it's perfectly normal for him to be down for more than an hour.The tech called her thinking Liam was having a seizure. Better safe than sorry!

We don't know why he suddenly went downhill very fast. None of his genetic line have reported cases of wobblers in the foals. His dam was carefully matched to a stallion. He was carefully fed by a wonderful woman with 40+ years of growing baby horses experience. He was turned out as a baby and yearling. All of the right boxes were checked. He also checked off the big ticket at risk checklist: big, fast growing, male, baby warmblood. What made the arthritis happen? Who knows. OSU ruled out injury since the issue is in more than one joint space. He has been brewing this for a while, it didn't just happen in the last two months. I do not think anyone knew about it, I want that clear. I do not think I was misled or lied to. The prevailing thought is he was brewing the arthritis and he might have slipped in the field playing with his new friends and tweaked it in a chain reaction. He also grew again at the end of May, where his chest widened a little so he wasn't so base narrow and he got taller. All of the above? None of the above? Wobblers is poorly understood and unfortunately is put in the "shit happens" category.

I do not think his PPE failed either. We had no reason to suspect neck issues and it doesn't make sense to do a PPE that costs 40% of the cost of the horse.

So itchy! He was always up for a grooming session with lots of currying.
Link to YouTube

I am going to try to rejoice and treasure the time I got to spend with him. Working on his confidence in the world around him, standing and leading skills, and marveling at his think first personality that lead to an incredibly brave, curious, and sensible baby horse with an old soul. I'll remember the head hugs he gave me when I cried into his neck the weekend he spent at OSU waiting to come home. How he groomed my leg with his nose when I scratched just the right spot on his neck. How quickly he came to trust me when I would tell him "step" from the halt when he was scared, and he'd pick up a front leg and put it on a mat or different color pavement or whatever was frightening him at the time. He was the horse I wanted, for sure. I was thrilled to make him a long term partner to do all the things with. I even considered a return to low level eventing because he was so sensible and had a great sense of self-preservation. I am heartbroken that it ended like this.

I taught him to step confidently onto a mat to prep him to be confident stepping into a trailer.

I feel like I failed him, even though I know we did everything that was reasonable. Putting him down was so difficult when he was bright, alert, hungry, and interested in life. He was perfectly aware he couldn't do things and was happy to walk slowly and didn't get riled up about being left behind. His mind was still perfectly intact while his body failed. In reality, I know he was dangerous. He could have wiped out at any time, injuring himself, another horse, or a person. He could have spooked and fallen and broken his neck or suffered some other traumatic event requiring an emergency vet to rush out to euthanize him... and he'd have to wait for that vet in pain. All of that logic still doesn't make it any better to have to euthanize a 2 year old who is still mentally vibrant.

Oh curiosity! He finally got over his fear of water, decided this puddle was fun, decided to roll in it, and then changed his mind half way down and kneeled for a while.

I had finally picked a registered name for him and sent it in with his DNA sample: Legato. "In music performance and notation, legato indicates that musical notes are played or sung smoothly and connected." It was a hope for connection and flow in the future. Maybe I should have kept it as Lawless, since he broke all the foaling rules and all the growing rules it seems.

At this point, I am not very upset at the further loss of my dreams. Those have been dead for a while. I have not been hungry in a while. I'm more upset at the loss of a budding relationship that should have had years to bloom and grow. But I am most upset about the life Liam never got to live. At least in his brief time here, he only knew grass and love, and never unkindness.

Legato "Liam"
April 30, 2017 - June 27, 2019

Wednesday, June 26, 2019

Liam's Pre-OSU Story

Before I get into OSU's findings, I want to go through what took us there.

I called the emergency vet many Fridays (5/31) ago when a hind end lameness turned full blown neurological. I already had an appointment for a vet to come out for a lameness exam to see if he pulled something stomping at flies, but swaying and staggering changed things... it wasn't a pulled muscle anymore, he was sick.

The emergency vet came out and took his temp (101.2, a very slight fever), did a run over of all his joints and general condition. She had him walk away from her, and turn small circles. She didn't even try pulling on his tail or stacking his hind feet- he was so unstable on his own feet that she didn't think it was fair. She didn't feel anything in the joints, but the elevated temperature and neurological problems bothered her.

Forgive my lack of polo, as I was packing for the barn before work, I realized I was out of barn shirts!

She pulled a ton of blood for various diseases, and Liam got a hefty dose of DMSO tubed into his stomach, a shot of dex, a shot of banamine, and oral vitamin e.

By Saturday morning, Liam's temp was back under 100 and he was much more stable on his feet. He'd been on stall rest for 4 days at this point.

*Gets on soapbox*

HAVE YOUR VET VACCINATE YOUR HORSE. I know it's annoying and more expensive, but let me tell you, having my vet vaccinate Liam at his PPE was a great decision. We knew exactly what he'd been vaccinated for and what manufacturer and what batch, etc. This whole incident was/is stupid expensive, but the vaccine manufacturer paid for one of the very expensive tests (a blood and nasal swab).

*Gets off soapbox*

I hesitate to share all that was tested for, because I don't want to scare people or put rumors out there. But I also want to take care of some rumors I've heard: we tested him for EHV (blood and nasal swab), west nile virus, EPM (blood only, no spinal tap since that has to be done at the clinic), lyme, strangles/rhino/upper respiratory diseases (guttural pouch culture). EHV was the big name disease of course, and the vet had to notify the USDA of a possible case. The USDA took it very seriously, and they visited the farm the next business day to check our bio-security and isolation. They made suggestions on keeping Liam properly isolated to keep the other horses as unexposed as possible, but also safely isolated so he didn't hurt himself. They discussed quarantine procedures if Liam was positive.

The geldings on the farm were redistributed to new fields, and Liam was put in 24/7 isolation with a tribute friend (literally, the barn owner turned him out with Liam and told him, 'may the odds be ever in your favor') in a field that didn't share a fence line with any other field, and both horses were banned from the barn. The virus doesn't live well outside the horse out in the sun, so this was actually ideal. Liam's stall was stripped and the barn and his stall were bleached.

Liam shredded his fly sheet in less than 24 hours... and didn't like Jaxon's clothes either. He did keep his shoofly leggins on though!

Luckily, all of this effort was for nothing. Most of the tests came back negative, including the big one, EHV. Yay! We did twice a day temperature monitoring, and his temperature was in normal range every time. As he started feeling better, he started fighting barn owner on having his temp taken, and taking his meds (liquid vitamin e syringed and marquis).

The one positive was one parasite for EPM. I'm not exactly sure what the test was looking for, but I am fairly sure it was the ELISA test. His ratio was 1:1000, and the "exposed" range is 1:250-1:4000.

From the ELISA tests detailed on this website:
Although a wide range of serum titers was observed for necropsy positive EPM cases, there was a trend for higher serum titers (≥ 1:4000) to correlate better with EPM.
Without the spinal tap to compare to, we could only make a guess that EPM was causing his issues. We started treating for EPM the day after his emergency visit without the results yet, deciding that treating him won't hurt him, but waiting could. The vet decided we should keep treating him, even though his blood serum value isn't greater than 1:4000, because his value is elevated and he's experiencing neurological problems.

Liam seemed like he was responding to the marquis and vitamin e when the vet came back to do a guttural pouch culture (because of the bacteria findings on the PCR nasal swab) on 6/6. His throat looked fantastic and healthy, so we expected the culture to come back clean (which it did). He was super alert, mildly fighting the vet, and in general being dramatic.

He took a downhill turn on 6/11. He came in from the field with swollen hind legs and a fever again (101.3). A video from the morning showed him looking very subdued, slow, and more neurological than he had looked in a while. The vet was called to make sure the hind leg swelling was *just* cellulitis and not something more sinister. He had some rubs on his hind legs, so we agreed the cellulitis was not directly related to the original ailment, but related in that he probably interfered because he's neurological.

By the time she got there, he was more neurological than the morning, but his fever had gone. She pulled blood to do a CBC, which they test in house. He got a shot of exceed as well. He might be more neurological as the parasites die off and increase inflammation in his body, or it might be the inflammation returning because it's not actually EPM that's causing the issue. EPM doesn't cause fevers though, but cellulitis can, but he didn't have cellulitis the first time around. The vet asked us to monitor his temperature twice a day to see if there's any kind of pattern and to see what kind of variation there is. He proceeded to spike fevers of 101.3 to 101.8 in the morning after cool nights turned out and return to 99.6 to 100.8 by the evening. It was a bit baffling. It did clear up as the cellulitis cleared up.

A visiting clinician had her boyfriend (a vet) do a look over of Liam at the end of her first day teaching at the farm, who thought he had wobblers. A third opinion was requested, and I sent her all the videos and information I could. She thought he might have broken his pelvic floor along with EPM, and encouraged me to take him to OSU immediately and not wait the 3 weeks until she was going to be traveling to my area.

So there's some back story.

Tuesday, June 18, 2019

Off to OSU We Go

I got a few more opinions on Liam over the weekend, and another vet reviewed his stuff Monday night. She told us to take him to OSU as soon as possible.

She suspects he has multiple issues going on- a right hind lameness as well as something impinging the spinal cord or up high behind (EPM, fractures of the vertebrae or pelvis, wobblers, etc).

I'm trying to scramble everything together to get him to OSU today, everything is falling into place, but I have to send him on ahead of me while I finish working this morning.

Tuesday, June 11, 2019

Liam Update, Part 1

I don't know when part 2 is coming. What was supposed to be a real update today or tomorrow was scrapped when he had new developments.

Pouting, back when he felt better.

We've tested him for ALL the things and have almost no answers.

He was very neurological (very unsteady walking) with a ever so slight fever (101.2) on 5/31. Heavy doses of meds made a solid improvement, but he seems to have back slid today.

I'm devastated basically.

Monday, June 3, 2019

Power of Thought

I feel like a broken record here, but think some good thoughts for Liam, he's feeling under the weather.

The emergency vet was called Friday, she pulled a bunch of blood to send out Monday, and loaded him up with drugs to cover most of our bases while we wait.

He's feeling a lot better after all of his drugs Friday, but he's still on a big cocktail and not symptom free.

Feeling a good deal better Saturday morning. 

Good thoughts y'all, because most of the diseases in this first round of testing aren't good.