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.

Dealing with loss

We’ve lost two horses this year – Saga in January after several months of ever-worsening mystery lameness, and now Oberon, suddenly, due to a twisted and displaced intestine from gas colic. I’ve owned horses for 17 years (Cash is my first horse) and these are the first ones I’ve had to put down. Both were young, healthy, and in their prime. To say it sucks is an understatement.

The good news in both cases is that I have absolutely no doubt in my mind, no second guesses, that we made the right decision at the right time for both of them. In Saga’s case there was literally nothing we could do, which we knew when we put him down but the true severity of the situation was revealed via necropsy. In Oberon’s case, colic surgery may have helped him. I say “may” because there are no guarantees.  The reality of surgery is that while some horses do great, others take 6 months to a year to recover, or never fully recover. There are lots of second surgeries, complications, and plenty of deaths on the table. I’m not knocking anybody who chooses to do surgery, it’s an individual decision (and not an easy one), but it’s something that we are not prepared to do.

As for how I’m dealing with things, the answer is OK. Yesterday I was on-and-off sniffly and didn’t get much done at work. The outpouring of love from the people who knew Oberon has been incredible. My poor husband is, as you might imagine, very upset and raw. What makes it worse is that he’s on a ship in Alaska right now, and not even accessible by phone. Imagine sending your husband an email that goes something like, “Honey, there’s no easy way to say this, but your horse is colicking and has a displaced intestine. Surgery is the only option and we've already discussed not going that route. I’m so sorry. Let me know when you get this.” That’s probably the worst email I've written in my entire life. Luckily we did manage to chat for a bit via Gmail, and I sent him emails from my phone when we were at the vet in the final moments, so he knew what was going on. Still, not being able to say goodbye in person must be awful. I’m very glad I got to be with both Oberon and Saga at the end. I’m also glad that it was fast and painless. Thank goodness for small mercies.

I don’t think saying goodbye ever gets easier, but maybe it gets… I don’t know, more real? Many years ago I was faced with putting Cash down due to impaction colic. We drove out to the hospital where he’d been all night to put him down. I’d come to say goodbye to him, but when we got there he was more comfortable so we decided to wait. We stayed with him all day, hugging him, grooming him, just loving on him. Somehow, by some miracle, he pulled through. Since that day, I think I’ve accepted – really accepted - that our time with them is fleeting. You could literally, at any moment, have to make that decision. In that moment with Cash, it went from being a theoretical “this is what I’d do if I had to say goodbye” to a real, in-your-face understanding of what it’s like and what you have to do for your horse. I was on the edge of the cliff that day, and by the grace of whatever deity you believe in, I got to step back. But I've never, ever forgotten that we’re really always on the edge of that cliff, most of us just don’t realize it. You might have to step off it at any moment, and every day you don’t is one more to be thankful for.

Saturday night I hit that cliff when the vet said “gas colic with impaction and displacement”. I had to sit down. I knew what it meant, but we agreed to try fluids to see if the impaction would resolve and allow the gas behind it to escape and let the intestine move back into place. Oberon was kept comfortable the entire time, and was feeling good enough at the end (due to the drugs) that he had some carrots, acted like his usual annoying self, and gave me a "hug" when I gave him a last hug from his dad. Sadly, medical treatments weren't enough – the displacement included a twist that we didn't know about until the necropsy was performed. But in the end, it wasn't a hard decision to make - it was the only one to make, because we’d already made it. There was a certain peace in knowing that we knew what we were going to do, because we’d discussed it before.

So I guess… be as prepared as you can. Really think about it and plan for it… it’s not fun, but it’s easier to make decisions ahead of time than try to make them when emotions are high. Know what you’re going to do, and know what your limits are. Try not to second guess yourself. Listen to your vet and your horse, even though your heart is breaking.

And give them one last hug. Every damn day.

Oberon: June 1 2002 - July 14 2013

Colic takes too many of them too fast and too young.

Rest in peace, Oberon. I hope that wherever you are, the bucket of treats is bottomless.