# Bone Scan for Mystery 'Offness' - Long



## victoriaocarroll (14 July 2017)

Hi All

Firstly I want to say that my vet, and my horses multiple therapists are all working on him and essentially the advice I will take will come from my vet but I just wanted to throw my story out there in case it rings a bell with anyone who can offer up a suggestion. 

The Horse
7 year old 17.2 warmblood, bought from Holland where he had started half steps at 6 and was doing a green change but mainly medium level work. Close spineous processes but 3 vets said on the xrays they really didn't look like they would be causing issues. Otherwise fine on the 5 stage vetting with full xrays. 

The Initial Issue
2 months after getting him I felt he was lame and after a vet and my trainer signing him off as sound I got a second opinion and in late November last year he was diagnosed with mild PSD to near front and off hind suspensories. We underwent a very slow and careful rehab and without going into too much detail he had shockwave, extended box rest, controlled rehab exercises, arc equine, physio every 4 weeks, rob Jackson saw him, acupuncture, ice vibe boots, equilibrium pad, back on track rug....you catch the drift, I did everything to fix him! 

The bigger picture
And fix him I did. The suspensories are now pretty much totally healed, he is completely sound when we nerve block and all the signs he was showing before have just about disappeared. But he still isn't right. We had also done some shockwave to his SI region because PSD is often secondary to something else and we thought perhaps it was his spine / SI region. 

Fast forward a couple of months and he was almost back to full work. He still seemed stiff to me but not lame and we went out competing last month (ele level dressage, training medium / advanced medium at home). At that stage he was 8 months post the mild PSD diagnosis. But he started not being able to hold his canter left and kept bunny hopping behind. He swings his right hind out on a circle rather than stepping under. His right hind quarters were incredibly tender and he didn't like his saddle being put on. It got to the stage that he couldn't even trot forward, on either rein. And he goes in and out of being fine one day to not being able to canter another day, to being fine to canter but can't trot the next. 

I've also noticed his right stifle clicks a lot but numerous practitioners have told me that's nothing to worry about. The big thing now is his right stifle / pelvis collapses in downwards transitions and often out hacking, particularly when we're going down a hill. This collapsing pelvis is always on the right side and happens both when ridden but also on the lunge, regardless of the rein he's on. 

The Treatment 
Following Rob Jacksons first visit we did a lot of strengthening exercises, carrot stretches etc and he was manipulated. But it didn't make much difference and Rob said on his most recent visit last weekend that few horses have flummoxed him like my boy does. He was put on Equitop Myoplast to help build up the muscles. I thought these 'new issues' were back related so got his close spineous processes injected. One week afterwards, I commenced riding and he was even worse, which is when he could hardly move forward at all. The muscles around his SI were also inflamed as the bump was more prominent than normal. The vet considered SI disease, and on the same day he was injected with Cortisone to the SI region with the provision that if it didn't work, we would go for a bone scan. He also had his right fetlock, hock and stifle xrayed / ultra sounded and nothing came up. He also nerve blocked his suspensories to see if the PSD had returned but they had no effect on him and previous ultra sounds suggested his suspensories had pretty much healed.  I also got him a new saddle JUST in case. He is also turned out overnight now and the 'bump' in his SI region has disappeared. He has had corrective shoeing since he was diagnosed with PSD and I've had three separate saddlers check his saddle, in case one of them spots something the others didn't. 

We commenced riding, one week after the hock / stifle injections, and he did get better, albeit very slowly. We are now about a month after the injections but he's still not right. This collapsing pelvis is more prominent, he has lost the swing through his body, he doesn't want to bend through the neck at all and his steps have become really choppy. 

I'm waiting to hear back from my insurance company to see if they will pay for the bone scan but I thought I would write our story on here to see if it flags anything with anyone. Rob Jackson fears the bone scan will return an 'inconclusive' result. My vet, physio, acupuncturist and chiro really don't know what is going on with him but maybe someone on here went through the same thing and has an alternative thought? He is my horse in a lifetime and I know many would have given up by now but I really REALLY want to try to fix him. I've had him for just over a year and 11 months of that I've been fighting to get back the horse I bought (and yes, I had his bloods run when I bought him). 

If anyone can help, I'd be over the moon to hear your thoughts. TIA!


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## SEL (14 July 2017)

Have they ruled out neurological issues?

Feel for you - awful not knowing what's wrong when all you want to do is fix it.


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## Goldenstar (14 July 2017)

So tough horses are just heartbreaking sometimes in your shoes I would bone scan it will give an overview of the horses bone health .
BTW Have you tried blocking the front feet ?


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## victoriaocarroll (14 July 2017)

SEL said:



			Have they ruled out neurological issues?

Feel for you - awful not knowing what's wrong when all you want to do is fix it.
		
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No, they haven't suggested it. I guess it would be next on the list. He my gut tells me it's something to do with the right pelvis area. I'm guessing neurological issues wouldn't show up on bone scan though....


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## victoriaocarroll (14 July 2017)

Goldenstar said:



			So tough horses are just heartbreaking sometimes in your shoes I would bone scan it will give an overview of the horses bone health .
BTW Have you tried blocking the front feet ?
		
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Well he was nerve blocked on all four legs when the PSD occurred and nothing showed up in the feet then. I'm definitely up for the bone scan....here's hoping my insurance company are too!


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## coss (14 July 2017)

I was going to suggest neurological as well. Not a shiverer but something along the same lines especially with the hip collapsing? Is there a trapped nerve or nerve damage so the brain sends a signal to the right hind but the message doesn't get through properly?


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## victoriaocarroll (14 July 2017)

coss said:



			I was going to suggest neurological as well. Not a shiverer but something along the same lines especially with the hip collapsing? Is there a trapped nerve or nerve damage so the brain sends a signal to the right hind but the message doesn't get through properly?
		
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Thanks Coss....definitely worth investigating. Although would his hind quarters be so sore if it was neurological? He's definitely showing signs of pain in the SI region too so at this stage the vet thinks it's SI disease, although Rob Jackson isn't so sure because the horse improved after manipulation of the area...


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## PorkChop (14 July 2017)

I would be tempted to block his back, ride him and see if it makes a difference, fairly cheap to do before shelling out on a bone scan.


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## coss (14 July 2017)

victoriaocarroll said:



			Thanks Coss....definitely worth investigating. Although would his hind quarters be so sore if it was neurological? He's definitely showing signs of pain in the SI region too so at this stage the vet thinks it's SI disease, although Rob Jackson isn't so sure because the horse improved after manipulation of the area...
		
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I'm no expert as haven't owned a shiverer - just worked with two very different ones and one more than the other. I would have thought they could get tense/tight in the muscles if the nerve signals aren't working right. I know the horses i worked with were tight and seen as lazy. As they were known shiverers and not mine I didn't question their care (quite a few years ago now). I hope you get to the bottom of it.


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## FfionWinnie (14 July 2017)

Have they considered a muscle myopathy. The time off could be the cause of that becoming an issue now, steroids and myoplast also wouldn't help. Just a thought.


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## victoriaocarroll (15 July 2017)

coss said:



			I'm no expert as haven't owned a shiverer - just worked with two very different ones and one more than the other. I would have thought they could get tense/tight in the muscles if the nerve signals aren't working right. I know the horses i worked with were tight and seen as lazy. As they were known shiverers and not mine I didn't question their care (quite a few years ago now). I hope you get to the bottom of it.
		
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Thank you. Yep, I hope we get to the bottom of it too. I rode him today and he was absolutely amazing so it's very bizarre. One minute he's great, the next he's not


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## victoriaocarroll (15 July 2017)

FfionWinnie said:



			Have they considered a muscle myopathy. The time off could be the cause of that becoming an issue now, steroids and myoplast also wouldn't help. Just a thought.
		
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Yeah definitely. I'll look into it anyway, thanks!


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## Northern (15 July 2017)

I have nothing useful to add, but I hope you can get to the bottom of whatever it is. Best of luck!


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## victoriaocarroll (15 July 2017)

Thank you! I'll post the bone scan results on here because I've struggled to find many stories that tell the results of the bone scan so maybe my story will be helpful to someone else!


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## Frumpoon (15 July 2017)

I've got a shivered but she's never lame so tats no help

Have you xrays the neck?


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## victoriaocarroll (15 July 2017)

Frumpoon said:



			I've got a shivered but she's never lame so tats no help

Have you xrays the neck?
		
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Thanks. I really don't feel like he is a shiverer. The bone scan will pick up on anything in the neck if there's something there. My thoughts are still that it's SI related. So weird though, today he went so well so it's obviously something that flares up and down.... &#55358;&#56596;


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## frannieuk (15 July 2017)

I could have pretty much written word for word with a mare I have - it turned out to be ulcers... Might be worth checking for yours?


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## vanrim (16 July 2017)

I was going to say get him scoped for gastric ulcers but someone else beat me to it. The collapsing stifle is classic ulcers.


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## victoriaocarroll (16 July 2017)

vanrim said:



			I was going to say get him scoped for gastric ulcers but someone else beat me to it. The collapsing stifle is classic ulcers.
		
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Oh wow guys, that's interesting, thanks! My vet and I had both chatted briefly about ulcers and said it is probably worth checking at some stage in the future but I had no idea that the collapsing stifle was a sign of gastric ulcers! That's a great help, I'll ask my vet to scope him in that case. Thanks!


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## victoriaocarroll (18 July 2017)

He goes in for his bone scan tomorrow and will be scoped for ulcers at the same time......GULP!


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## emfen1305 (18 July 2017)

Good luck for tomorrow! I can relate to some of what you wrote in your first post. After being scoped and treated for bad ulcers, my boy still went in for a bone scan after not being quite right, he looked iffy behind and not wanting to move forward. Scan was clear bar the hocks, he was xrayed and then injected (very expensive way to find out he had mild arthritic hocks!) but it did rule other things out (kissing spine, SI joint etc). Anyway this was back in Jan and then he came back into work and was getting consistently better but he still has bad days now! We don't know exactly why but his attitude plays a big part (i've posted a bit about his laziness). Definitely not suggesting it's just an attitude problem, I'm sure your horse is a lovely honest boy but that's just my experience. What the bone scan did do is help me rule out all of the other things running through my head so I can happily push him through his bad days in good knowledge that he is pretty healthy! Good luck for the scan and the scope, hopefully it will help you understand what's going on!


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## victoriaocarroll (19 July 2017)

emfen1305 said:



			Good luck for tomorrow! I can relate to some of what you wrote in your first post. After being scoped and treated for bad ulcers, my boy still went in for a bone scan after not being quite right, he looked iffy behind and not wanting to move forward. Scan was clear bar the hocks, he was xrayed and then injected (very expensive way to find out he had mild arthritic hocks!) but it did rule other things out (kissing spine, SI joint etc). Anyway this was back in Jan and then he came back into work and was getting consistently better but he still has bad days now! We don't know exactly why but his attitude plays a big part (i've posted a bit about his laziness). Definitely not suggesting it's just an attitude problem, I'm sure your horse is a lovely honest boy but that's just my experience. What the bone scan did do is help me rule out all of the other things running through my head so I can happily push him through his bad days in good knowledge that he is pretty healthy! Good luck for the scan and the scope, hopefully it will help you understand what's going on!
		
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Thanks so much for the message....the not knowing is the absolutely worst part. And when they have good and bad days, and people only see the good days so don't believe you about the bad days....GAH!!!! Luckily my vet is very supportive so has been on board with everything I have suggested thusfar. But honestly, i'll eat my hat if it's not ulcers at this stage! I take him home Saturday morning so should have a post next week to update on the findings. Fingers crossed the results show he has ulcers (I've never wished for my horse to have something so much in my life....feels very wrong!)


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## vanrim (19 July 2017)

Yes please keep us updated.


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## DabDab (19 July 2017)

FfionWinnie said:



			Have they considered a muscle myopathy. The time off could be the cause of that becoming an issue now, steroids and myoplast also wouldn't help. Just a thought.
		
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Ditto this. My lad used to have frequent hip collapse, and it still happens occasionally if he's having a bad day and walking downhill. It might not fit if he was a free easy to school horse when younger, but might be worth considering if you draw a blank with everything else


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## victoriaocarroll (20 July 2017)

DabDab said:



			Ditto this. My lad used to have frequent hip collapse, and it still happens occasionally if he's having a bad day and walking downhill. It might not fit if he was a free easy to school horse when younger, but might be worth considering if you draw a blank with everything else
		
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I'll definitely keep it in the back of my mind. The stifle collapsing isn't constant and isn't the biggest thing that he has issues with but we'll see what the bone scan and ulcer scope throw up and go from there


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## victoriaocarroll (24 July 2017)

Well.....the results are in. It's NOT ulcers, which I had totally convinced myself he had! He showed zero signs of either gastric or hind gut ulcers so at least we can mark that one off the list! 

He was showing a mild to moderate hot spot in the SI region, which is what I feared. However he has been turned out at night (so is out for approximately 13 hours a day now) for the past 2 weeks and my GOD what a difference it has made. His hind quarters have already changed shape, he's moving beautifully in the school and he isn't as narky when I'm taking up. I got a beautiful passage out of him yesterday and he felt willing and engaged and was pushing well from behind.

The bone scan also showed a hot spot in his right hind pastern joint but we should be able to manage that with injections, fingers crossed. 

Over all he is a much happier horse and I'm a much happier rider! I was worried the bone scan would throw back inconclusive results as I already guessed he had some SI pain but I wouldn't have guessed the pastern joint was an issue. 

Hes actually been feeling so much better, we are going to head out competing dressage this weekend so I'm over the moon with him. I now have a plan in place, I know what to look out for and I know that when he isnt feeling great, time off ISNT a good plan for him as horses with SI pain shouldn't be kept in their stable and need as much movement as possible. 

Also, the vet said that it is quite a low grade hot spot (in fact all his 'issues' weren't astounding by any stretch of the imagination) and my horse is incredibly sensitive. So while the majority of horses would get on with the work, he will always let me know if anything isn't feeling as it should. Diddums! 

Thank you all for your suggestions and advice, you're a great bunch all together


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## coss (24 July 2017)

Sounds like good news and very interesting about the fact that rest isn't the way forwards!


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## PorkChop (24 July 2017)

This is great news, all sounds very manageable


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## victoriaocarroll (25 July 2017)

coss said:



			Sounds like good news and very interesting about the fact that rest isn't the way forwards!
		
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Yes, SI issues are one of the only things that box rest actually makes worse! Often PSD is associated with SI related pain and while box rest is good for suspensory issues such as PSD (which my boy had a mild case of and was on extended box rest for) any SI issues will be worsened if they are contained to their box. It needs movement to prevent the muscles around it seizing up. You wouldn't guess he has any issues at all, now he has been turned out!


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## hopscotch bandit (26 July 2017)

victoriaocarroll said:



			I'm guessing neurological issues wouldn't show up on bone scan though....
		
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No you are wrong there VC as neuro issues are due to impingement of the vertebrae and the pinching of the related nerves a bone scan would show narrowing in the space between the spinal column. Usually for suspected neuro when a neuro exam is insufficient proof an MRI can be conducted and they will inject dye into the spinal cord to show any impingement.However as this would necessitate a GA it might not necessarily be the best idea for a horse who would struggle to rise to its feet, as coming around from anaethasia is often fraught with problems with the potential for a giddy horse to break a leg. So a giddy horse with neuro problems would be even more of a danger.


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## whiteflower (26 July 2017)

hopscotch bandit said:



			No you are wrong there VC as neuro issues are due to impingement of the vertebrae and the pinching of the related nerves a bone scan would show narrowing in the space between the spinal column
		
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Not quite, not all neuro problems will show on a bone scan and even with the example you give it will only show on a bone scan in the narrowing is active and remodelling, not it it's set and inactive, even if there is still nerve impingement. A bone scan is a very useful tool but as far as Im aware it cannot rule out all neuro issues !
I hope you horse continues to improve, you seem to be doing everything you can, it's so difficult when they are not right when the cause isn't clear


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## vanrim (30 July 2017)

Very interesting thread. Thanks for the update.


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## ycbm (30 July 2017)

hopscotch bandit said:



			No you are wrong there VC as neuro issues are due to impingement of the vertebrae and the pinching of the related nerves a bone scan would show narrowing in the space between the spinal column.
		
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Bone scans don't show the bones, HB. I'm pretty sure that they only show what areas of the bones have taken up the radioactive isotope more than other areas, and that only happens where there is active remodeling going on. Not all neuro issues are caused by bones clashing. I'm pretty sure a standard wobbler impingement with a narrowing of C3 and out of step C4 won't show on a bone scan unless the bones are also arthritic. But the nerves will be being pinched, causing the symptoms. 


OP, I really pleased that you have some answers and a happier horse


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## hopscotch bandit (31 July 2017)

I saw my friend at the weekend whose horse had wobblers and on chatting to her realized now that I said in my previous post MRI when I meant to say myelogram.


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## victoriaocarroll (17 August 2017)

hopscotch bandit said:



			No you are wrong there VC as neuro issues are due to impingement of the vertebrae and the pinching of the related nerves a bone scan would show narrowing in the space between the spinal column. Usually for suspected neuro when a neuro exam is insufficient proof an MRI can be conducted and they will inject dye into the spinal cord to show any impingement.However as this would necessitate a GA it might not necessarily be the best idea for a horse who would struggle to rise to its feet, as coming around from anaethasia is often fraught with problems with the potential for a giddy horse to break a leg. So a giddy horse with neuro problems would be even more of a danger.
		
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Sorry for the delayed response on this one hopscotch bandit! Thankfully his head, neck, and back were all clear and we've figured it out so I'm glad to say it isn't neurological, but thank you for the interesting info!


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## victoriaocarroll (17 August 2017)

Thank you everyone for your advice and thoughts, yes, he has gone from good to better and has finally got his zing back! We went out to compete and qualified for dressage nationals in September, I'm over the moon. It's unbelievable what a difference a bit of turnout makes. If anyone wants to follow his progress I've been keeping a blog (although haven't gone into much detail about his health issues cos that doesn't cause for a fun read!!)

https://huntingformydressagehorse.blogspot.co.uk/


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## amandaco2 (18 August 2017)

neuro exam, possibly xray neck. have ulcers been ruled out?


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## amandaco2 (18 August 2017)

ops just read the updates


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