Thursday, October 2, 2014

What every horse person should know about head shaking syndrome - In memory of Echo

Long-time readers may remember my Baby Racehorse, Echo. Sunday marked one year since I decided that we could not treat his terrible disease, head shaking syndrome, and donated him to UC Davis to be part of their research program on head shaking. For those of you who are not familiar with this disease, I'd like to take a moment to share what I learned in hopes that if you come across a horse with these symptoms, you'll be able to identify them and know what your options are.

Quite probably the fanciest horse I will ever own.

Headshaking is a syndrome where the horse involuntarily flips or shakes his head in a vertical motion. The tell-tale action is the sudden jerk, like a bee flew up his nose. Horses also frantically rub their noses/faces on anything to relieve the pain, often causing sores or cuts. It most commonly occurs in TB geldings between 7-9 years of age. It can be seasonal, with summer being the worst time. The initial trigger is unknown - there are over 60 proposed triggers, but thus far research shows nothing concrete.
So gorgeous

What causes the sudden jerk is a response to neuropathic pain along the trigeminal nerves in the face. Vets think it's a sudden, sharp pain like the pain of a migraine headache in a human. In Echo, this pain manifested itself in several ways. He rubbed his face so hard on trees, fence posts, and the water trough that he cut his face and mouth. He would stand with his head submerged - up to his eyes - in the water trough. Because Echo's HSing was photic (caused by strong sunlight), he could not eat during daylight hours, and would stand with his face in his feed tub, unable to take a single bite yet so obviously hungry. He went from being a sweet, calm horse to one that was irritable, spooky, and unpredictable. Under saddle, he would slam on the brakes to rub his face frantically against his front leg, and several times almost pulled his bridle off. He'd fling his head in the air unpredictably, or tuck his nose to his chest in response to the pain in his face, then buck and bolt. He would also "black out," where he would carry his head up and to the right, completely oblivious to anything in front of him, any voice or rein commands, anything. At his worst, he was dangerous to handle and ride, and was in terrible, terrible pain.

Because the cause of head shaking is unknown, it's difficult to treat. I would best describe it as throwing the kitchen sink at the problem and hoping that something miraculously helps the horse. We tried a UV-blocking mask (this helped some), a nose net (helped some), magnesium (might have helped?), cyproheptadine and carbamide (both antihistamines, and both on the USEF illegal drug list), and Dex pulse therapy. We considered doing a permanent block of the trigeminal nerve, but long-term success (that is, more than one year) in most cases is low and there is a high chance of making the HSing even worse, so we chose not to follow that route.

Echo's UV mask

About this time, I found another horse owner in Austin who had been managing her HSer for the last 8 years. She kept him at a VERY nice boarding facility, and was able to do a few schooling H/J shows with him. She wrote me this about her experiences (reposted with her permission):
"I feel so much pain for you reading your story and thinking back over my years of heartache trying to manage Ian's HS.  I spent so much money trying everything under the sun.  Once his HS was "managed" I spent a ton of money on body work etc to undo whatever was probably already there and whatever all the tension from the pain caused.  I certainly saw amazing results and had a horse I loved to ride, but in hindsight, my choices in how to manage him leaving no stone unturned because I couldn't bear to see him in any pain, the money I spend trying everything under the sun plus keeping what did work going did which was 10s of thousands over the 8 years, going to the barn to take care of him every single night, not riding in lessons most of the year because I only rode him after dark which also then meant I rarely saw my husband during the week because I'd be at the barn until 10pm all seem pretty crazy.
I know I kept going with Ian long after anyone else would have and if I'd decided to put him down I knew any of my friends would have done it long before me, but I look back and can't believe what I went through and what I did for him every single day for 8 years.  I honestly was relieved in a way when his vision started to go [and I had to retire him].  He was still doing great and fun to ride but I just couldn't do the constant maintenance anymore.  Had I known he could live outside in retirement I would have retired him a long time ago. However, it's possible he wouldn't have done so well in retirement a long time ago.  His HS was the best it had ever been when I retired him.  That "best" still required a lot of effort and money.  I look back and wonder what life would have been like if I'd put him down before I committed much of my life to trying to make him well.  
One of the hard things with HSers is that you know for some horses the solution is simple so it feels like if you just keep trying, you'll find that thing that makes your HSer better.  And if you quit, what if there really was a simple solution and you just didn't find it.  So many HSers seem to be really talented and wonderful horses too.  It's torture and if I were giving advice to a friend 8 years ago with Ian, knowing what was in store, I would have advised that friend to quit trying and put him down to end his pain.  I physically had the money to spend but never would have imagined just how much I would sink into maintaining him and in hindsight I think I would also advise a friend to not only end the horse's suffering but it's not worth the emotional and financial cost.  I love Ian dearly and can't imagine my life without him but the cost, in so many ways, has been significant.   Obviously I didn't take that path I would advise and it's easier to give that advice than take it but I'm glad to hear you are being realistic about the possible outcome. There is no easy answer.  My research does tell me this condition can be extremely painful.  My opinion is that when Ian is snorting and wiggling his nose, that is not pain, but when he flicks his head or flings it, that is pain and when he flings his head so hard his feet come off the ground, that is significant pain.  So I tried to keep that in mind when I was trying to get his symptoms under control and had decided he would not spend another summer suffering. "
This letter was perhaps the nicest gift anyone could have given me. She laid out exactly what Echo and I were in for with the head shaking, in terms of time, money, and emotion - but most of all, the pain that Echo was in. I realize that there are many people out there with HSers that successfully manage the symptoms, or they try for years to find that "magic bullet" that helps their horse.  With Echo, I simply could not stand to see him in so much pain despite everything we tried. I chose to donate him to the UC Davis research program on head shaking, in hopes that he could help teach us something about this awful disease, and maybe find a cure.

So my plea to you, as horse lovers and advocates, is that if you see a horse exhibiting these behaviors, don't immediately attribute them to the horse being naughty - it may be a response to sudden and severe pain. And if you're shopping for a horse, keep your eyes open. This is a terrible disease, and the cost is so high for both horses and humans.

For more detailed information about my experiences with Echo, here are a few links to old blog posts (Warning: these are not happy posts):

I hope you are at peace, my little Echo. It was the best I could do for you.

32 comments:

  1. I can't believe it's been a year. I'm in tears reading this. I'm so sorry you had to put him down, but it probably was the best decision. I can't imagine the kind of pain he must have been in. :(

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    1. A1D, it was the only decision to make. Living in that kind of pain is no way to live, IMO.

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  2. Wow it's been a year, I remember reading your posts about Echo and feeling so so so horrible about what you were going through. He was such a cool horse and it was incredibly sad that your time with him was so short. You did the right thing for him, poor guy :/

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    1. He was a cool guy and I'm just sad that he had to go through so much.

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  3. I remember when you made that decision -- and how painful it was. Pistol flips her head in bright sunlight but doesn't seem to be in any pain. As long as she is ridden on shady trails she is fine. This is helpful though; I will watch her to make sure it doesn't get worse and if it does, your post will be helpful in knowing the options and best descision for her.

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    1. Annette, I'm no vet, but Pistol's symptoms do sound like a mild form of HSing. One thing that surprised me from my experience is just how many horses have mild symptoms. When I started describing Echo's symptoms to other horse owners, almost all of them said something like "oh, there was a horse in the barn that did that in the summers. Nobody knew why, we just kept him in during the day and that helped." That's part of the reason I wrote this post, to help inform others. I am glad that Pistol's symptoms are easily managed - I wish Echo's could have been.

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    1. Thanks. I am actually OK with the whole thing - it still makes me sad, but I know we did the best we could.

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  5. He was a beautiful horse. I hadn't found your blog a year ago so it's nice to know your history.
    My friends horse is a head shaker but only in the summer, we thing it's due to pollen. A nose net helps as does a steroid thingy squirted up his nose. Not sure how he's doing now, I must ask his owner.

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    1. TFP, I am really glad your friend's horse can be treated with a nose net and steroids. With some horses it's that easy. With other horses, nothing seems to help, or it takes so long to figure out what will help and in the meantime the horse is in unimaginable pain. Such an awful disease. Hugs to your friend's horse.

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  6. I can't believe it has been a year *hugs*

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  7. thanks for sharing this. Echo was such a lovely boy, and i am so sorry for what you went through, even knowing it was the right decision.

    this is also very timely, as my barnmate is suspecting HSS in her TB gelding - tho so far a nose net seems to help. I sent her your posts on the topic since they were so informative. it just makes me very sad :(

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    1. Emma, please let your barn mate know that she is more than welcome to contact me privately if she would like more information. Many vets aren't familiar with the syndrome so getting help can be a challenge. There is a Yahoo group for it, which might be helpful. I am glad the nose net helps him - hopefully that is all it will take to keep him comfortable. Best wishes to her and her boy.

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  8. *hugs* time creeps and yet flies by.

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  9. too bad the nose net didnt work, its worked for a couple of friends. Sorry for this outcome. x

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    1. The nose net helped when I was riding, but not enough to stop the "blackouts". And he couldn't wear it all the time, or he wouldn't be able to eat. If I had been able to find a way to manage his pain enough for him to live in a pasture, I would have done it, but even that didn't seem to be an option. I am so glad it's worked for friend's horses, though. That's such a blessing.

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  10. I remember reading your posts, and this one too, brings tears to my eyes; It's just not fair and it breaks my heart. Throughout the entire situation you maintained such a level of composure that I have always been extremely impressed. It takes a true horsewoman to do what you did for Echo, and for other horses with head shaking syndrome. I admire you and your decisions in this impossible situation <3

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    1. It certainly isn't fair, and it's heartbreaking. But no matter how much it hurt my heart, it hurt Echo in a way I couldn't imagine. And that's how one becomes able to make those impossible decisions.

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  11. I'm so glad you're putting information out like this. I haven't dealt with a confirmed headshaker, but when I was looking at other issues, I was always trying to find information from other owners in the same place. This is an absolute treasure trove for someone like that.

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    1. Thanks, SB. I was mostly hoping to educate others about this. Glad you found it useful!

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  12. Tearing up right now, and sending you hugs. What a sad, unfair, unfortunate situation. Thank you for sharing about such a painful thing.

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    1. Sarah, thank you. It's mostly behind me, but I'll never forget it.

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  13. So sorry you and Echo had to go through all that. You did right by him. (also can't believe it's been a year already)

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  14. I can't believe it's been that long and yet it seems like it was longer than a year. Time is so flexible at times. lol You definitely did the right thing for Echo. The love, time and effort you put into helping him was considerable. I think he lived a better life with you than he would have just about anywhere else. Hugs!

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    1. Thanks, and thanks especially for all your love and support through all that!

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  15. Echo's story is very sad. He was so lucky to have you even if it was briefly.

    Do you think his racing owners were oblivious to his condition?

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    1. Val, I have often wondered if this previous owners knew. I don't think they did. He was in a pasture for 2 years before I got him, just got fed and had his feet done, so I doubt anyone would have noticed then. But, there is some indication that environment can trigger HSing, so it's possible that there was something in Texas that triggered him. I did ask his racing owner, but never got a response. I'll probably never know.

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  16. wow..so heartfelt. The best we can do, is only the best we can do. At least Echo had experience obvious care and love.

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