Friday, August 23, 2013

Echo lesson videos - Hindsight for headshaking symptoms

Because I am actually starting to feel positive about riding Echo again (and thanks to all of you who listened to me whine and mope about HS essentially being a death sentence), I went and looked at some videos of our last jumping and dressage lessons. I’d never gotten around to posting them before, because shortly after the lessons, things went downhill dramatically and I stopped riding. Plus, it’s hard to look at videos when you think you’re never going to get to ride your very lovely horse ever again.

As I watched, I noticed that was had some really nice moments. And then I saw the really, really bad moments. Moments where he flipped his head. Moments where he bucked and bolted. Moments that I now know were his reaction to the pain he experiences from headshaking syndrome. Hindsight is, as then say, 20/20.

I don’t actually remember the head flipping much, but I do remember the buck-and-bolt thing getting worse and worse. At the dressage show, he “spooked” at a horse doing tempis, at another horse in the mirror, and a few other random things. But Echo’s not a spooky horse, so why would he suddenly have such a dramatic reaction? When we went XC schooling, he did it several times, and I thought it was in response to another horse coming at him – except that in the worst instance, the horse was 50+ yards away, so it didn’t make sense. Now, I don’t think he was spooking at anything other than the pain in his face.

So here are the videos. First up, jumping. Please ignore my form and look at my lovely gonna-be-an-eventer-not-a-hunter pony. And look for the head flip at 7 seconds in.

Second, our dressage lesson, in which we have the best canter transition EVER at 3 seconds. Didn’t see that one coming, did you? But lest you get too excited, watch him start to suck back as we come around the circle, tuck his head to his chest at 12 seconds, then buck and bolt at 14 seconds. I yelled at him and he came back to me, but still, it’s not the kind of behavior you want under saddle. Plus, how can you reprimand a horse for a response to pain that he cannot control?

My hope is that with the Mg he's now on, and with a second round of Dex Pulse Therapy (we started today, per my vet), that his symptoms will be much better under saddle. In fact, I have a lesson scheduled with a new eventing trainer on Sunday! My plan is to ride Red (YAY FEERLESS WAR PONY!!!), but bring Echo and longe him and ride him lightly in the (relative) safety of an arena. Hubby is traveling again, and so are all my regular riding buddies, and I don't want to get on Echo unless there's someone there to dial 911. Just in case, lol! We'll see how the HS symptoms are then... it will be the first real test.

Wednesday, August 21, 2013

Headshaking - Moving in the right direction (we hope)

I know, it’s been a while. I could use the excuse that I was on vacation, but that would only be partly true. Initially I didn’t post because I didn’t have any good news to share, and then it was because I was afraid to jinx things. So here’s what we’ve been up to:

The last time I posted, we were about to try low levels of Dex to get Echo’s HS back under control. His symptoms were as bad as they’d ever been. Well, we tried the Dex (4 mg on Aug 5, and 6, then 8 mg on Aug 7 and 8), and it had absolutely no effect (in contrast, he was almost symptom-free after the first dose of the Dex Pulse Therapy). Echo continued to be unable to eat at dinner, as well as flicking his head and jerking. 8 mg of Dex was the max my vet wanted to try, so we discussed plans B, C, and D.

  • Plan B – start him on 10+ G (that’s GRAMS, not milligrams) of Magnesium per day. I ordered Quiessence, and bought human-grade Mg pills to feed in the meantime. The jury is out as to why Magnesium works for some HS horses, but it does work. Cheap, easy, and legal. Definitely worth a try.
  • Plan C – start him on a combination of Cypro and Carbamide. These drugs are USEF illegal and can have nasty side effects, but they have a high percent chance of working… at least for a little while. I ordered almost $200 (1 month of Cypro + 1 week of Carba) from a compounding pharmacy.
  • Plan D – the vets (I’m working with two) would do more research on nerve blocks for his face. This is the same block they use for dental work, and the more I learn about it, the more I don’t want to go there. 

I started the people-grade Mg on August 5, and the Quiessence arrived on the 9th so I discontinued the Mg then. We also changed up Echo’s feeding schedule – he was getting more and more frustrated about not being able to eat dinner, pawing, walking around, and generally being (understandably) pissy. So, on the 6th I gave him a flake of alfalfa at dinner instead of his grain, and after a moment of hand-feeding, he dove right in and polished off the entire flake. Since then (and it’s been two weeks), we have been 100% successful in getting him to eat a flake of alfalfa at dinner time, and then eat his grain between 9 and 10 pm, when it’s dark and we do night check. It’s not the easiest schedule to deal with, but it’s working and he’s eating.

By the time the Cypro and Carba arrived on the 14th, Echo had been eating well for week and the flipping symptoms had gone away entirely. I consulted with the vet and we decided that the massive doses of Mg were doing something, and to hold off on the big drugs unless we absolutely needed them. It’s now been about two and a half weeks since we started the Mg, and we seem to be in a steady place. Echo eats, and the worst of the symptoms have gone. He’s not flipping, rubbing his face frantically, snorting, or sneezing. However, he is still chewing on wood and the water trough, and when he’s having a bad day, he’s very aggressive to Cash and Red. Cash currently looks like a chew toy, poor man, but when Echo’s feeling OK, they are BFFs and eat out of the same dish. It’s sort of an abusive relationship.

On the 8th, another lady in Austin whose horse was also recently diagnosed with HS kindly came out and tried some very gentle massage techniques on Echo. I’d noticed that because of the jerking and flipping, Echo had developed a very odd set of muscles on his neck, and I figured he was probably pretty sore. Unfortunately, we had to take off his Guardian mask to do the massage, and in less than 5 minutes his HS symptoms started to appear. It’s hard to know whether it was the sunlight (it was early evening) or the fact that we were working on his poll and neck that caused the symptoms to appear, but they were quite strong and sudden. We put his mask back on and worked on his butt and shoulders instead, which he seemed to like. I should probably do an actual experiment and take off his mask during the day to see if the symptoms reappear so quickly, but frankly, it’s hard to do anything that I think will cause his symptoms to worsen.

Guardian mask - what all the cook kids are wearing.

I actually took Echo on a short trail ride on the 10th, and other than trying to bite Red (a relic from his racing days, I think – he tries to bite any horse that’s next to him), he was pretty good for not being ridden in almost 5 weeks. We had two episodes of head-rubbing, but if that’s the main symptom under saddle, then I’m OK with that. Yesterday (the 20th), I longed him briefly for the first time in 6 weeks, and while he was quite zoomy and didn’t want to pay attention, it went well enough. No sneezing, snorting, or any other symptoms. Of course, it was dusk so the light was very low, but still, it’s a start.

My plan right now is to continue light work and try to get Echo legged up again. I was looking at some videos of our last lessons, and thinking how we had some nice moments. It would be nice to get that back and improve upon it. I am also going to talk to my vet about trying another round of DPT. Echo’s symptoms are much better, but the fact that he’s still chewing on things tells me that he’s still uncomfortable. If my goal is to keep symptoms manageable, I’m there, but if my goal is to make him completely comfortable, we've got a ways to go. And I really don’t want him to be miserable.

Saturday, August 3, 2013

Headshaking Syndrome - good days and bad days

I've started a daily diary of Echo's headshaking symptoms, along with treatments. I'm trying to make a page that shows my spreadsheet, but so far Blogspot is not cooperating with Google Docs, so you'll have to wait for the nitty-gritty details. Let's just say that there are days when the only symptoms he shows are sneezing and a little nose-rubbing, and days when he's so uncomfortable that cannot eat at all, unless it's pitch black out. Those are the days that break my heart.

Before I get into things, let me define the behaviors that Echo shows as a result of headshaking:

  • Rubbing his nose/face on anything and everything, hard
  • Snorting and sneezing (most noticeable when he's running around, or while eating)
  • Pausing while eating - just sort of standing in front of his feed bowl, looking like he wants to eat but just can't. These pauses can last from a few seconds to minutes, and sometimes they're as long as his entire dinner time. This is when he just can't eat.
  • Flipping his head and neck in an up-and-down motion
  • Jerking his head up and in, as if he's been stung on his nose by a bee

We started Dex Pulse Therapy (DPT) on Saturday, July 20. He got 60 mg on the 20th and 21st, 40 mg on the 22nd and 23rd, and 20 mg on the 24th and 25th.

During and for several days after DTP, his symptoms were reduced to almost nothing. He'd dive into his dinner and polish it off, whereas before we started DTP he practically couldn't eat his dinner, and exhibited head flipping and jerking symptoms while trying to eat. I was gone the 26-28th, but MC house-sat and said Echo ate everything. It was also rainy and cloudy while I was gone, and I definitely think that helps. Unfortunately, by the 30th he was pausing for long periods of time while eating, and on the 31st he simply would not eat dinner at the usual time. We managed to get him to eat at 10 pm when it was pitch black out - he ate quite happily and showed no headshaking symptoms then.

Echo has a Guardian mask, which blocks 95% of UV rays, which arrived on the 20th. He's been wearing it from sunup till full dark every day since. I don't know how much it really helps him, but I suspect it does as he shows no symptoms at all when it's dark out. I am kind of unwilling to take the mask off during the day and see how bad his symptoms become, but we will probably do that at some point in time as part of the data collecting.

I've also started keeping Cash and Echo up in the barn during the day. They hate being stalled, but the barn is essentially a big run-in shed, so I simply put all their hay up in the shady area, and that seems to keep them up for the most part. I've also started to feed more alfalfa, per the vet's request. Echo has suddenly decided that it's OK stuff, so he and Cash split a couple of flakes, along with a bucket soaked beet pulp, every morning. They also still get regular hay, so I can't really tell if the change of diet is making a difference. I guess time will tell.

Since the symptoms have gotten so much worse again, and we still have two weeks to go before the next round of DPT, I consulted with my vet yesterday (the 2nd) about other treatment alternatives. Starting today (the 3rd), he's on 4 mg of dex daily, along with 6 G of Magnesium. Generally, folks don't have a lot of success with low doses of dex, and long term usage carries quite a few risks, but anything is worth a try right now. The Mg helps calm the nerve firings, so maybe that will reduce his symptoms as well. We're going to try this for a week or two and see where we're at, then reassess.

Unfortunately, there aren't a lot of other options to try, and none of them seem to be 100% effective. If the dex and Mg don't help, we will likely try a short-term nerve block to see if that works. If it does, then we'll do a longer-term block. I could try Cypro (an antihistamine), but it's really expensive, causes colic and laminitis, and is testable. It also tends to stop working after 6-18 months of use.

This disease seems to be a big guessing game, where you throw things at your horse and hope like hell that something works to relieve his pain. We're still looking for something that works, because the alternative to finding something is really too sucky to contemplate.