Hip dysplasia/coxofemoral subluxation

[summer_rain]

I have a miniature horse who I found with acute, severe lameness in her right hind limb about 2 weeks ago. We originally thought she had her stifle locked, but now its seeming like it may be a coxofemoral subluxation instead. The vet took radiographs, and her femur was sitting in the joint properly on the image she got, but the appearance of the femoral head and acetabulum were slightly abnormal, and we're suspicious that it might be going in and out intermittently when she bears weight. She isn't a surgical candidate due to both the amount of time that has passed since the initial injury, as well as some other abnormalities noted in her bone structure that would increase the risk of fracturing her femur during surgery. I also don't have the finances for surgery at this point. The vet recommended euthanasia when she was out the other day and seems to think she will never recover enough to have a good quality of life. I've had her since she was 3 months old, this mini along with her mother (who sadly passed a few years back) were my first horses, and she's only 15 so I really don't want to give up on her. She's always just been a pet/pasture potato so I don't need her to be athletic...just comfortable and happy. Has anyone had any experience with this and had success with non-surgical management?

 

[Cayuse]

I've had no experience with this but I just wanted to say I'm sorry that you are going through it. The thing that jumped out at me is the part about not being a surgical candidate because of increases fracture risk during surgery. Would this increased fracture risk also be in play if she was able to get pasture sound? That would be something to consider. Has she been on an anti-inflammatory and did it help? Can you get a second opinion from a specialist who does lameness rehabs (if your vet isn't one, sounds like you have a good vet though)? I might be inclined to keep her contained in a very small area with pain management and see how things progress with scheduled evaluations and see how "Mother Nature" brings here along.

 

[summer_rain]

I've had no experience with this but I just wanted to say I'm sorry that you are going through it. The thing that jumped out at me is the part about not being a surgical candidate because of increases fracture risk during surgery. Would this increased fracture risk also be in play if she was able to get pasture sound? That would be something to consider. Has she been on an anti-inflammatory and did it help? Can you get a second opinion from a specialist who does lameness rehabs (if your vet isn't one, sounds like you have a good vet though)? I might be inclined to keep her contained in a very small area with pain management and see how things progress with scheduled evaluations and see how "Mother Nature" brings here along.

We have her in a small pen and she's on anti-inflammatories and ulcergard. I sent her radiographs to a radiologist to look at, and her regular vet is going to try and consult with a local specialty hospital. The radiologist didn't agree with her vet's assessment of an increased risk of fracture based on what she saw and thought the abnormality was just artifact, but a surgeon at the specialty hospital who also looked at the radiographs did agree that her bones have significantly decreased density, and said she absolutely wouldn't recommend surgery based on what she saw. So I really don't know what to make of that right now. We're waiting on some bloodwork results to see if we can identify any metabolic imbalances that might give us an idea of whether or not her bones are truly brittle or if it was an artifact of the x-ray machine. If her bones truly are brittle, there would still be a risk of stress fractures if she is pasture sound, but I think if there is a metabolic issue causing it the hope would be that if we correct that, then we would remove that risk. I told the vet I wanted to give her some more time, and I also asked to try a muscle relaxer since its possible that her quadriceps contracting too strongly is playing a role in the luxation, so she's starting that tonight. She can lie down, but once she's down she can't get up without help and I don't want her to get stuck when I'm not around and wind up unable to get to her food or water. I'm just sort of at a loss with this.

 

[JFNM miniatures]

We have her in a small pen and she's on anti-inflammatories and ulcergard. I sent her radiographs to a radiologist to look at, and her regular vet is going to try and consult with a local specialty hospital. The radiologist didn't agree with her vet's assessment of an increased risk of fracture based on what she saw and thought the abnormality was just artifact, but a surgeon at the specialty hospital who also looked at the radiographs did agree that her bones have significantly decreased density, and said she absolutely wouldn't recommend surgery based on what she saw. So I really don't know what to make of that right now. We're waiting on some bloodwork results to see if we can identify any metabolic imbalances that might give us an idea of whether or not her bones are truly brittle or if it was an artifact of the x-ray machine. If her bones truly are brittle, there would still be a risk of stress fractures if she is pasture sound, but I think if there is a metabolic issue causing it the hope would be that if we correct that, then we would remove that risk. I told the vet I wanted to give her some more time, and I also asked to try a muscle relaxer since its possible that her quadriceps contracting too strongly is playing a role in the luxation, so she's starting that tonight. She can lie down, but once she's down she can't get up without help and I don't want her to get stuck when I'm not around and wind up unable to get to her food or water. I'm just sort of at a loss with this.

Oh, what a difficult experience ! I've never been through this particular problem, but my experience with health problems in horses tells me this is hard....

 

[Taz]

Is she wanting to lie down a lot? Maybe you could put her on a runner when you're not around. A line across her pen high enough so she can't get her head down but can rest it halfway comfortably clipped to her halter? Then you just need to put her hay and water where she can reach. It might work if she's OK staying up. What a hard situation, I hope someone find something to help her.

 

[Cayuse]

Sounds like you have really good vet who is willing to communicate with everyone even if everyone doesn't quite agree. I'll keep my fingers crossed the muscle relaxant helps. Is there any chance of x-raying her once more to rule out the artifact?

 

[summer_rain]

Is she wanting to lie down a lot? Maybe you could put her on a runner when you're not around. A line across her pen high enough so she can't get her head down but can rest it halfway comfortably clipped to her halter? Then you just need to put her hay and water where she can reach. It might work if she's OK staying up. What a hard situation, I hope someone find something to help her.

She does lie down a lot unfortunately, and we're hesitant on tying her to keep her standing since she struggles to bear weight on her right hind, we're concerned about laminitis or some other sort of breakdown occurring in her left hind limb from overloading it. But I'll ask the vet if maybe we could try something like that just for when I need to be out and then she can still lie down if needed when I'm at home. Thank you!

Sounds like you have really good vet who is willing to communicate with everyone even if everyone doesn't quite agree. I'll keep my fingers crossed the muscle relaxant helps. Is there any chance of x-raying her once more to rule out the artifact?

We did repeat radiographs, and her bones still look abnormal. But the vet doesn't have too much experience x-raying minis and every time she's out the machine has also been a little tempermental, so I'm still not 100% sure if she truly has brittle bones or if its more that the machine settings were a little to high for a mini, or just technology being iffy with the digital radiographs. We did pull blood to check her calcium/phosphorous levels and some of her hormone levels so I'm hoping maybe that will shed a little light on if there's something going on that would explain her bones being brittle, or if its all normal and then maybe the bone density seeming off is just a function of the machine being more suited towards full sized horses. Her vet has been really great about doing research and listening to consults from other vets, my poor mini just seems to be a little bit of an anomaly and a confusing case unfortunately. I'm thinking of maybe looking into acupuncture or laser therapy to see if that might do anything to make her feel a little better? She's still very alert and sociable when I'm sitting with her, I can't bring myself to give up on her when she's still acting like her sassy little self.

 

[Cayuse]

I just had a thought, magnesium might also help her muscles if she is having spasms.

 

[summer_rain]

I just had a thought, magnesium might also help her muscles if she is having spasms.

That's a really good idea, thank you! I'll try and get some asap and give it a shot!

 

[Taz]

You could try doing some of the Masterson Method with her. mastersonmethod.com or youtube. It's very easy to do and not invasive at all. It might help relax some of the muscles.

 

[summer_rain]

You could try doing some of the Masterson Method with her. mastersonmethod.com or youtube. It's very easy to do and not invasive at all. It might help relax some of the muscles.

Thank you for that! Its absolutely worth a try! She got stuck down overnight and was pretty stressed when I found her and helped her up in the morning. I haven't seen her lie down since then and I'm thinking maybe she's afraid now. I have a vet who is also a licensed chiropractor and certified in acupuncture coming to look at her for a second opinion. Keeping all my fingers crossed something will work but I'm afraid options might be running out and seeing her so lame is breaking my heart.

 

[summer_rain]

I made the choice to let her go today. She stopped eating altogether, became systemically ill, and I could tell she was done. Based on her symptoms, including ventral edema, I'm now afraid that she had bute toxicity and this outcome is my fault. She was only 15 years old, I had her for her whole life, she and her mother were my first horses, and I am heartbroken and beside myself that this could be my fault.

 

[Willow Flats]

I'm really sorry to hear this. My heart is heavy for you. Please go easy on yourself as you have enough grief to bear. You were going to great lengths to get help and find answers to help heal her. Praying for peace for you in the midst of this great loss. {{Hug}}

 

[Taz]

I'm so sorry. Please don't blame yourself. You did everything you could for her and more than a lot would have.

 

[JFNM miniatures]

Very sorry to hear this... Sending hugs your way.

 

[Cayuse]

I'm sorry to hear of this. It's not your fault. You did everything possible to help her and she was very, very lucky to have you as her owner.

 

[summer_rain]

Thank you all for the replies. I think her being relatively young, having such a severe and rapid decline, and never even getting quite to the bottom of what caused the lameness is just making it feel like there isn't any real closure. I can't stop thinking about all the "what ifs", or if I had pushed for a second or third opinion sooner. She was just so special, I still can't wrap my head around the fact that she's gone. My husband and I got married this past summer with just our parents there for the ceremony, and the highlight of it all was that meant she got to be in a few of my wedding pictures, and also due to COVID she also got to take part in my virtual white coat ceremony for school.

 

[Cayuse]

Beautiful pictures, thank you for sharing them.

 

[MerMaeve]

Sorry for your loss. At least you have sweet pictures to remember her by.

 

[Willow Flats]

Really sweet pictures! I'm glad she got to share that special time with you.