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):

• Diagnosis - Headshaking
• Headshaking - good days and bad
• Making the impossible decision

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

Making the Impossible Decision for Echo

It’s hard to keep a blog when you don’t feel much like writing, because you haven’t got much positive to say. This is a long post, and it sums up what’s been going on in the last month.

A month ago, I was trying to be positive. The Quiessence was helping Echo. His headshaking symptoms were better, but still there. He had started eating at normal times, which made management easier.

But Echo was still in pain. He would bite the barn half-wall or the edge of the water trough and hold it for minutes at a time. He’d bite Cash constantly. He liked to submerge his face in the trough, up to his eyeballs, holding his breath until he had to come up for air. I can only guess that the water provided some relief, since he also likes to have his nose hosed (but now hates having his body hosed, and flings his head about maniacally while being bathed).

So we tried another round of Dex Pulse Therapy, which did nothing for him at all. Then we tried the Cypro and the Carba, which maybe helped his sneezing and snorting a little (which makes sense, it’s an antihistamine) but did not affect any of the other headshaking symptoms.

In desperation, I began to consider doing a permanent block of the branch of the trigeminal nerve that goes to the upper nose. Unfortunately, the block requires general anesthesia, the success rate is less than 50%. In a significant number of horses, the attempted block makes the symptoms worse, and the result is having to euthanize the horse. I even contacted USEF to see if they would allow a horse with the nerve block to compete, but they would not. Given the cost and the risk factors, plus the fact that Echo would not be able to show, we decided that the permanent block was not an option.

I rode him a few times, always in an arena. Under saddle, he rubs his face so hard that he has almost pulled his bridle off several times. I have learned to do up the throatlatch much tighter than usual since having a bridle come off mid-ride isn't safe. He’s gone from being a confident baby jumper to stopping in front of a single ground pole and refusing to go over it, to the point of rearing up and spinning away. He sucks back, tucking his nose to his chest, and he has become very spooky, whereas before he was a pretty cool customer.

Because I felt like I was running out of options and was no longer able to view Echo’s behaviors objectively (that is, green horse issues vs. headshaking issues), I put him in training with Paige, who I take jumping lessons from. We agreed to a two-week trial, so see if he would improve at all. Two weeks is up today, and I’m sad to say that while I can tell he’s been ridden by a pro (he doesn't fall in as badly to the right and he’s more forward in general), the HS behaviors are still there. The scariest one is what Paige refers to as “blacking out,” where he sort travels with his head way up in the air and to the right and just sort of zones out. You can’t turn him or stop him, he’s so focused on the pain in his face that everything else ceases to exist. I can’t even imagine how dangerous this would be if it happened in front of an XC jump, or out foxhunting.

Paige told me that if I want to keep trying, she’s willing to help me, but we could spend huge amounts of time and money and it could go nowhere. Despite being on a whole bunch of drugs and supplements (the bill for that stuff alone is over $250/month), he’s not getting better. In fact, he’s back to rubbing his face so hard that he’s got cuts on his nose and gums. I had hoped that with the shorter days, his HSing might be seasonal and the symptoms would improve, but they are not.

What it comes down to is this:

• Pain – Despite all the drugs (and we are literally out of options), Echo is still in pain, even just out in the pasture. I can’t make him feel better, and this will be something he will have to suffer for the rest of his life.
• Safety – I don’t feel safe riding Echo. He’s not being naughty, but he cannot control his responses when his face hurts, and we cannot predict when an episode will occur. He also flips his head viciously when being bathed, and when his symptoms were bad this summer, it was almost dangerous to handle him because of the head flipping.
• Emotions – Any time your horse isn't right, it’s emotionally draining. You keep hoping that the next thing will work, and then the next, and the next. When do you stop trying? Horse-wise, I have already been through the deaths of Saga and Oberon this year, and I am having a very hard time emotionally handling Echo’s HSing. 

And then randomly through a Yahoo group, I found another horse owner in Austin who has 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. "

Y’all, that’s what Echo and I have ahead of us. I just can’t do it, and I can’t put Echo through that. 

So, I have decided to donate Echo to the University of California at Davis. He’ll be shipped out there in the next 7-10 days. Dr. Madigan and his team are doing ongoing research on headshaking, and Echo will be part of their research program. It’s likely that they will observe him and run tests for a few weeks, and then he will be PTS. My hope is that he will be able to contribute in some way to further the knowledge of this awful disease, and of course, that one day soon he’ll be able to run in the great golden pasture pain-free.

I am honestly not sure what to do in the meantime. I had thought to take some pictures, but like with Saga, I want to remember him when we had our blue-ribbon “winning” day at our first h/j mini show, instead of now with cuts on his face from rubbing. Every time I see him I cry, so that’s hard too. I just feel kind of lost and adrift and sick to my soul.

My poor little Echo-Gecko. I am so, so sorry we couldn't help you.

Photo courtesy of Lauren Mauldin.

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.

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.

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.

The dangers of texting your vet (sort of NSFW)

So I was texting with my vet yesterday about dexamethazone dosages for Echo for the pulse therapy we want to try for his headshaking. As I was texting, I noticed that my iPhone auto-corrects "dex" to "sex". Suddenly, my innocent medical questions took on a whole new meaning. This was the text conversation I *almost* had with my vet:

So, how much sex do I need to give him every day? How often should I give it? Twice daily or is it OK to just give it at night?

And then...

Can I order sex online or do I need to come to the office to get it? 

And this morning, after we got the dosage protocol from another vet:

I'll give him sex right now since it says to do so in the morning. Thanks!

Fortunately I caught the autocorrect before I sent the texts, but I texted my vet after to tell about the near-miss. At least she's got a great sense of humor!

And the hits just keep on coming - Echo has been diagnosed with Headshaking Syndrome

I was planning for this post to be cute pictures of the kitties, with lots of happiness to counteract my earlier posts, but it's not to be. I don't know what I did to piss of the universe, but seriously, I'm at the end of my rope. To top off Oberon's death, trouble with all three of our vehicles (which resulted in the very untimely purchase of a new truck), and 7 chickens dying in last week's heat wave, Echo was diagnosed yesterday with Headshaking Syndrome.

Insert a whole lot of four-letter words here. And crying. Lots of crying.

Remember this post about Echo's ulcers, where I mentioned that he was flipping his head and not eating? I got a video of him doing it. (Note that the stuff on the ground that he's eating is soaked beet pulp, which he had just dumped out of his tub. The green bucket on the fence has 2 scoops of soaked Senior feed in it.)

At the time, I thought this behavior was ulcer-related - that is, he was flipping his head and not eating because his belly hurt him too much to eat. Turns out, it's not ulcer-related at all. Instead, it's 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, 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 the research shows nothing concrete.

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. Can you even imagine trying to eat your dinner, and every time you try, it feels like someone is stabbing you in the face? Or when we take a break during a ride, every time we stop, he insistently rubs his head/nose HARD on his LF leg. I thought it was a bad habit from the track, but it's a symptom of Headshaking Syndrome. In fact, he rubs so hard and so often on posts, trees, ANYTHING, that he's got cuts on his nose. My poor, poor Echo.

I've been wracking my brain as to when this started. I called Adopted Horse Mom yesterday (in tears, ugh), and we talked about if he'd done it during the month he was with her (Feb 20-March 15). He had not. I was not able to ride much the first month he was here (March 15-April 15) due to a bite to the saddle area and his mangled RF hoof, so I would not have had the opportunity to notice anything during that time. I remember my first few jumping lessons on Echo (April 15th-ish), he flipped his nose a few times when we were first warming up, and Paige commented about flies. In between May 19 and July 1, I did a number of dressage lessons where Echo snorted and sneezed when we started working, and Jeanne commented about allergies. The frantic rubbing of his face has been pretty consistent since I started dressage lessons (I remember commenting to JD during our first lesson on May 19 that it seemed to be a habit). Then somewhere between June 28 and June 30th he wouldn't eat his dinner, and that's when I really started to get worried.

Then I started trying to figure out if anything had changed. He's on a ton of supplements so it's possible that one of those was the trigger. My vet wants me to take him off everything and stop feeding him hard feed, and provide him with an all-alfalfa diet. I am really, really hesitant to do this for several reasons:

• I've had a really hard time getting weight on him. He currently gets 15 lbs of Senior per day, including a bedtime snack. He got the same feed when he was at Adopted Horse Mom's and didn't show any symptoms, so I'm pretty sure it's not the feed. 
• The ulcer meds (Zantac and Omeprazole) I've been giving him have helped TREMENDOUSLY - he's back to his snuggly self, and we even had a nice grooming session the other night where I got all his itchy spots and he made silly faces (as opposed to him pacing frantically, pawing, wringing his tail, and trying to kick while I groomed him just two weeks ago). He's halfway through a six-week course and I'm afraid that if we quit now, the ulcers are just going to come back worse than ever and he's going to be even more miserable. Also, he was exhibiting mild headshaking symptoms BEFORE I put him on Omeprazole the first time, so it's very unlikely that it's the trigger.
• He doesn't eat alfalfa. I've tried pellets, cubes, flakes, and chopped. He won't touch pellets. The cubes he will eat if hand-fed as treats, but he won't touch them if they are soaked. He eats the leaves off the flakes and leaves everything else. He sort of eats chopped alfalfa, but only if it's mixed with Senior and only in small quantities. Also, for me to get 15 lbs of alfalfa down his throat every day, I would have to keep him in a stall during the day. He HATES being stall-kept, paces, and chews the walls, (even if I keep his BFF Cash with him) plus it's not good for his ulcers. I can't win.

I thought about when I'd seen him doing it, and figured out that he mostly won't eat his dinner. He generally polishes off his breakfast well enough, and his bedtime snack is no problem. I've seen him flip his head while eating hay too, during the day, but he seems to graze peacefully enough when he's out in the late evening. Many horses that are headshakers stop doing it when they are in a dark stall, because light exacerbates the problem. As a test, I went out this morning and fed a little earlier than usual, and left the barn lights off. Echo ate steadily, with no flipping or pausing - until the sun started to come up. I put his fly mask on in hopes that it would offer him a little protection, and after a bit of encouragement, he finished his breakfast, again with no symptoms. Last night I snuck out to the barn, again leaving the lights off, and watched him eat hay. No flipping or rubbing. Looking at my notes, his symptoms have also been markedly better during dinner time for the last several days, but we've had rain and it's been quite overcast. Given all these things together, I think his headshaking is caused by bright sunlight. I also think that since it started showing up in late spring/early summer, that it's seasonal. 

After reading everything I could about it last night, I'm pretty down. There are some treatments we can try, but most of them aren't very effective. Most horse owners seem to try a bunch of things and hope that one works. So here's the plan as of right now:

• I've ordered him a Guardian Mask, which blocks 95% of UV rays. If I'm right and his is photic, this should work miracles. 
• I've ordered him muzzle nets for riding. The constant contact of the net seems to help some horses - it's worth a try since I cannot ride him in a big mask at shows (assuming I have some hope of riding and showing him).
• We're going to try a dex pulse - four days of high doses of dex, every 21 to 28 days. It helps some horses, not others. It would be nice if it worked for Echo.
• Melatonin helps some horses, has low side effects, and I can get it OTC at Costco. However, it must be given at 5pm every day, year'round. It sort of fakes the horse out that it's always winter, so it can help horses that are seasonal headshakers.
• Long-term nerve blocks (lasting 2-4 months) seem to work in about 70% of cases. On one hand, I really like this option, because it means that Echo would be pain-free. On the other hand, he won't be able to feel his face at all, and that seems like a bad thing. 
• We may try cyproheptadine, which is an antihistamine and seratonin antagonist. It's definitely way down on my list of options, because side effects include colic and sedation. It's also a testable substance, and it sometimes work for a while and then stops..

So there you have it. I'd like the universe to please stop now. I'm usually really good at rolling with the punches, but I'm finding it really hard to cope. I am so physically and emotionally drained right now, I don't have anything left. In the grand scheme of world problems, I know this isn't that big of a thing, but right now it feels huge. I really hope that we're able to find a way to help Echo, and soon. It's hard to see him in pain.