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Mare in Sling - Looking for Facility in Penn-Ohio Area

Equine-Reproduction.com Bulletin Board » General Mare Questions - Volume 2 » Mare in Sling - Looking for Facility in Penn-Ohio Area « Previous Next »


Author Message
 

Susannah Hart
Weanling
Username: Glennedynmorgans

Post Number: 50
Registered: 10-2005
Posted on Wednesday, April 22, 2009 - 03:14 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

A few weeks ago I posted a message about needing a sling for my mare. We ended up trailering her to OSU. She has something very rare - Obturator Paralysis - as a result of a dystocia and cannot stand on her own or walk. She also appears to have damaged some branches of her sciatic nerve as well. They did an EMG on her yesterday and it showed signs of serious damage. We're going to check again in two weeks to see if there are any changes. If the results are positive then we will need to find another facility close that is willing to manage her in the sling and that the vet can visit weekly to monitor her. OSU will loan out a sling for her and I also have a Liftex sling lined up if necessary.

If you know of a place, please contact me. As long as she's happy in the sling I need to give her a chance. I won't quit on her unless she's uncomfortable or unless we know for a fact that she won't recover. She's too nice of a mare to give up on.

Susie Hopkins
Latrobe, PA
 

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Username: Ajvtbs

Post Number: 593
Registered: 01-2009
Posted on Thursday, April 23, 2009 - 11:16 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I'm really hoping the next EMG tests are more positive. I was thinking her sciatic nerve may be damaged as well. I'm so sorry to hear that.
 

Susannah Hart
Yearling
Username: Glennedynmorgans

Post Number: 52
Registered: 10-2005
Posted on Thursday, April 23, 2009 - 05:56 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Today I found out that they didn't test her inside thigh because she was in a lot of discomfort during the test. I'll be sure to insist they test there next time to see how badly those muscles are affected. From what I've seen and read it sounds like her femoral nerve could be damaged. What are signs of sciatic nerve damage?

What do you think we can expect to see in two more weeks? Could there be no change?
 

Ad TB
Breeding Stock
Username: Ajvtbs

Post Number: 615
Registered: 01-2009
Posted on Friday, April 24, 2009 - 09:52 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Hi Susannah, I'll try and give you a run down of the femoral and sciatic nerves. Hopefully I can remember all the actions and supply of the nerves.
It's rare to damage the femoral nerve. The nerve mainly supplies the quadriceps muscles. These are the muscles that act on the stifle joint. They cause the joint to extend or straighten. Severe damage to this nerve has serious consequences as paralysis of the quadriceps muscles prevents fixation or locking of the stifle joint, the whole leg cannot bear weight as the stifle will give away and buckle. Nerve damage can often be compensated for by support or action of the surrounding muscles but there is no compensation for femoral nerve damage. The femoral nerve and obturator nerve have the same origin ie they arise from the same part of the lumbar spine (L4-L6).

There are two gluteal nerves, the caudal gluteal nerve and the short cranial nerve. The short cranial gluteal nerve supplies muscles that act as both flexors and extensors of the hip (tensor fascia latae, middle, deep and superficial gluteal muscles) these are the large rump muscles of the horse. If these are affected you'll see gross mucsle wasting in the horses rump.
The caudal gluteal nerve supplies the superficial gluteal muscle and some of the hamstring muscles, the parts that act to extend the hip or bring the leg back behind.

The sciatic nerve passes between the deep gluteal muscles (rump muscles), it gives branches to several small unimportant muscles before it divides into two important nerves. The common peroneal and tibial nerve.

The common peroneal nerve supplies (throught it's branches of superficial and deep peroneal nerves) the muscles that flex/bend the hock and extensors of the fetlock joint. It also provides sensory (sensation) to the lower leg. Paralysis of the common peroneal nerve results in an overextension of the hock and flexion of the fetlock and hoof. The foot will be bent and curled up but will support weight if placed on the ground. Compensation will occur with time.

The tibial nerve supplies the hamstring muscles, the muscles that run down the back of the rump under the tail and the gastrocnemius muscles, the muscles that run down the back of the thigh to the hock. Damage to the tibial nerve results in overflexion/overbending of the hock and overextension of the fetlock and hoof. The leg can only bear weight if the quadriceps muscles or femoral nerve is not affected as this will fix the stifle joint but generally the leg cannot bear weight.

I hope this is helpful, I'll look up my anatomy book when I get home and see if I've forgotten anything but I think I've got most of in. It's certainly given my brain a work out to remember the path of each nerve.

On the time scale. Nerve regeneration is very slow. If the nerve is not completly severed (broken in half) regeneration is about 1mm per day. Most of the nerves are very long so It will take time. Unfortunately if the nerve is completly severed there will be no improvement in her current condition, they should be able to see this from the EMG though. If the nerve is just bruised the time frame should be much shorter only a few weeks as once the acute inflammation dies down the nerve will start to activate again. The type of medication is important to reduce inflammation, bruising and swelling. What kind of meds do they have her on?
 

Susannah Hart
Yearling
Username: Glennedynmorgans

Post Number: 53
Registered: 10-2005
Posted on Friday, April 24, 2009 - 10:56 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

The EMG showed no activty in the gluteal muscles. The vet said it wasn't a good sign for there to be no activity this early on and that it was a sign of severe nerve damage. He also said that there were signs in the gluteal muscles of dinnervation. That's what had me wondering about the femoral nerve.

She has a hard time getting her right hind back underneath her but will bear weight on it when she is standing with it more under her and also if you help position it back under her hindquarters more.

The vet tech said Janie was flexing the right leg more and wasn't knuckling the hoof over much anymore when she steps wrong.

The atrophy in her hindquarters isn't too bad. It looks a little dipped in comparison to the left side.

Right now Janie is only on Bute twice a day. They did have her on gabapentin but took her off of it this week as it didn't seem to make a difference. What kind of medicine do you think she should be on? When she was was getting DMSO through an IV but only the first week.
 

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Username: Ajvtbs

Post Number: 617
Registered: 01-2009
Posted on Friday, April 24, 2009 - 12:21 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I'd suggest DMSO IV for 7-10 days, Bute or Finadyne, then might consider Dex or some other form of steroids. Steroids can cause laminitis which is a major problem if she's only weight bearing on 3 legs, new research as to the benefit od steroids in nerve regeneration is also questionable. They may also consider Trental 400, it's a vasodilator and a good way of preventing laminitis before it occurs. If she's on prolonged bute she also needs some form of anti-ulcer treatment. It's often the laminitis that poses the major threat not the nerve damage. The other thing I thought of is Magnesium has been found to have benefit in treatment of nerve injuries as has vitamin E and vitamin B1. Magnesium often comes in a liquid supplement form to be added to feed as a calming agent for excitable horses. You can also get a supplement with Magnesium, vitamin E and Vitamin B1.

The gluteal muscles are not innervated by the obturator nerve but by the caudal and cranial nreves, there are 4 gluteal muscles. The caudal gluteal nerve supplies the gluteus superficialis (which is incorporated with the vertebral part of biceps femoris and semitendonis, two hamstring muscles). The cranial gluteal nerve supplies gluteus medius (the most powerful hip extensor and hip abductor), gluteus profundus, tensor fascia latae. If she can weight bear on it it's unlikely that the femoral nerve is affected. She may have caudeal gluteal, cranial gluteal, some sciatic and obturator damage. The fact that the EMG showed no activity is not a great sign but don't lose heart yet, this can change.

The other thing that would give an indication of which nerves are damaged would be to map the sensation she can feel in her leg as the various nerves also provide sensory innervation to the skin. To do this they need to use a haemostat/ clamp and squeeze the skin between and make a map of where she can feel and where she can't.

(Message edited by ajvtbs on April 24, 2009)

(Message edited by ajvtbs on April 24, 2009)
 

Susannah Hart
Yearling
Username: Glennedynmorgans

Post Number: 54
Registered: 10-2005
Posted on Friday, April 24, 2009 - 02:28 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I forgot - they are giving her vitamin E. Are there recommended levels for Magnesium, Vit E & B1?

They're doing the next EMG on 5/1. That will be only 1.5 weeks apart. Do you think much can change in that time? It will be 30 days from when she was injured.

Do they test the skin with the EMG?
 

Ad TB
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Username: Ajvtbs

Post Number: 618
Registered: 01-2009
Posted on Friday, April 24, 2009 - 02:38 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Another few notes that I found in an anatomy book

Inability to extend the stifle to support weight on the hind limb is seen with L4 to L5 nerve root or femoral nerve disease; the patellar reflex is reduced or absent, the quadriceps muscle is atrophied, and sensation of the skin is reduced or absent on the medial (inside) surface of the limb. Inability to actively flex the stifle, hock, and foot or to extend the hock and foot is seen with lesions of the sciatic nerve. The horse will support some weight if the femoral nerve is spared, but will stand knuckled onto the dorsum (front) of the hoof with the hock excessively flexed (bent). If only the peroneal branch of the sciatic nerve is affected, the hock will be overextended and the hoof knuckled. If only the tibial branch of the sciatic nerve is affected, the hock will be overflexed and the foot overextended. The prognosis for tibial or peroneal nerve lesions may be better than that for sciatic lesions, so differentiation is important.
The pelvic limb flexor reflex is diminished or absent with sciatic nerve lesions. The gastrocnemius reflex is diminished or absent with lesions of the sciatic or tibial nerve. The cranial tibial muscle reflex is diminished or absent with lesions of the sciatic or peroneal nerve.

The distribution of denervation muscle atrophy can indicate whether the sciatic or only one of its branches are involved. Atrophy of gluteal, semimembranosus, semitendinosus, and all muscles below the stifle indicates a lesion of the L6 to S2 nerve roots as they exit the spinal cord. If the gluteal muscles are normal but the others are atrophied, then a lesion of the sciatic nerve is located at the sciatic notch or the proximal(upper) two-thirds of the femur. Atrophy of the cranial tibial or gastrocnemius muscles alone indicates a lesion of the peroneal or tibial nerve, respectively. If superficial sensation is reduced or absent on the cranial(front) and caudal (back)aspects of the limb and in the perineal region on the same side, then a lesion of the L6 to S2 nerve roots is likely. With peroneal nerve lesions, superficial sensation on the cranial(front) surface of the hock and tibia and on the dorsal (front)aspect of the foot is reduced or absent. With tibial nerve lesions, superficial sensation of the caudal (back)surface of the hock and tibia and plantar (sole) surface of the hoof is reduced or absent. Sciatic nerve lesions cause a loss of superficial sensation in the cranial (front as far as hock), caudal (back as far as hock), dorsal (front from hock to hoof), and plantar regions (back from hock to sole of hoof). A loss of deep pain may be associated with sciatic nerve lesions (tested using haemostat.

Heat application, massage, and stretching of tendons should be performed for 15 min 2-3 times/day to keep muscles, tendons, and joints healthy while the nerve is regenerating. If voluntary movement, nociception (voluntary stimulus to painful stimulus), and spinal reflexes improve over 1-2 month, the prognosis is good.

The main thing would be to do a thorough neuro exam, map the sensation, muscle atrophy and look at the movement and reflexes. This should easily determine exactly which nerves or part of nerves are involved and where the injury to the nerve is located. A neruo exam is time consuming but it will give valuable information.
 

Ad TB
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Username: Ajvtbs

Post Number: 624
Registered: 01-2009
Posted on Friday, April 24, 2009 - 05:21 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

You might find this interesting. These are clips of my mare Wunder who suffered a spinal cord injury in July of last year. She was paralysed in her right for and hind leg. She was unable to walk when it happened and couldn't lie down, she would fall down and be unable to get back up. She was 5 months pregnant when the original videos were taken. The videos are taken at about a week after her injury took place. The last video is of her taken today
http://www.youtube.com/watch?v=tI6ul-8dAp8
http://www.youtube.com/watch?v=qsR-0L6ookw
http://www.youtube.com/watch?v=UPQS0Ijsfg4
http://www.youtube.com/watch?v=WDonh16kiqg
 

Susannah Hart
Yearling
Username: Glennedynmorgans

Post Number: 55
Registered: 10-2005
Posted on Tuesday, April 28, 2009 - 09:32 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Hello,

Such a beautiful mare. How long did her symptoms persist? How did you manage her? Did she fall over alot?

Yesterday the vet called and said her quadracep muscle is contracted and when she's not bearing weight on her right hind that the foot is suspended in the air. He recommended euthanasia. I spoke with my mom about it and this morning they're going to let Janie out of the sling to see what she does. I left a message for the vet this morning and asked him to hobble her back feet to see if she can stay up hobbled, without a sling. I don't know if it will work or not. We also want to see if she can manage to stand up on her own. She's been in the sling since last Sunday morning, so over a week. I don't know what her chances are at this point. Given the results of the EMG last week, it does seem that she has severe nerve damage. We were originally planning to do another EMG this Friday. I'd like to wait and do that and see what it shows. Could the results show worsening of the nerve damage? I don't want to give up on her but if she needs several months of sling care - we can't afford it.
 

Susannah Hart
Yearling
Username: Glennedynmorgans

Post Number: 56
Registered: 10-2005
Posted on Tuesday, April 28, 2009 - 10:47 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Janie did not like the hobbles and they also didn't prevent her from falling over when she did not have the support of the sling. After a rest they encouraged her to try to stand. She is so weak now. The first two weeks she would really try and fight and would prop herself up with her front legs and 'dog-sit' but not any longer. My poor, sweet girl. I can't believe I have to lose her now.
 

Ad TB
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Username: Ajvtbs

Post Number: 718
Registered: 01-2009
Posted on Tuesday, April 28, 2009 - 02:41 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I'm so sorry to hear that Susannah. It's so difficult to lose a mare after all the hard work and sleepless nights you've probably had. It's heartbreaking. I'm holding back the tears thinking about how you must be feeling because I know how much it would have hurt if I'd lost my mare.

She had complete paralysis for about a week and would fall over all the time. One night she fell over and we couldn't get her up, she was so distressed and then she just lay flat out with her eyes closed and her legs limp, every now and again she'd have violent tremors and her whole body would shake uncontrolably. We poked and prodded her and she showed no response what so ever. We called the vet after three hours, it was about 3am in the morning at this stage and the vet came and thought euthanasia was the most humane thing to do. At the time I hated seeing her in such a bad way but I couldn't let him do it. I said I'd stay with her all night and if in the morning she was still unresponsive we'd do it. Eventually after several hours she came around and with a lot of difficulty we managed to get her up, it was like she was in shock and exhausted from trying so hard to stay standing.

After 10 days she showed marginal improvement in sensation but no better movement. It was about a month before she was walking better and about 4 months until she was significantly better.

Again I cannot express how sorry I am, I know you did your best for Janie and wanted her to recover so much. I was thinking about her today. My thoughts are with you.
 

Kathee McGuire
Senior Stallion or Mare
Username: Katheekj

Post Number: 1202
Registered: 12-2005
Posted on Tuesday, April 28, 2009 - 03:19 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I don't even know what to say other than you and your family are in my prayers.
 

Terry Waechter P.R.E. foals
Breeding Stock
Username: Watchman

Post Number: 669
Registered: 01-2007
Posted on Tuesday, April 28, 2009 - 10:57 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Your mare is lucky that you would do so much to save her and so compassionate to let her go if she can't be well..you are in my thoughts and prayers...I admire you and hope you will take solace in doing the best for your mare.
 

Jan Owen
Senior Stallion or Mare
Username: 1frosty1

Post Number: 2384
Registered: 04-2006
Posted on Tuesday, April 28, 2009 - 11:20 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Prayes and deepest sympathy..you fought the good fight for your mare....she will be made new at the rainbow bridge.....hugs Jan
 

Jennifer Seaman
Weanling
Username: C_j_quarterhorses

Post Number: 44
Registered: 01-2009
Posted on Thursday, April 30, 2009 - 09:35 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Susie, I'm so sorry, prayers for you. Wish there was more we could do. I too admire you for fighting for your mare...Jen
 

Susannah Hart
Yearling
Username: Glennedynmorgans

Post Number: 57
Registered: 10-2005
Posted on Wednesday, May 20, 2009 - 02:32 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

We received the post mortem results on Monday. The damage to her obturator nerve and several large branches of her sciatic nerve was permanent. The laminitis in her left hind hoof was also worse than we'd thought - she'd rotated 9 degrees. Another thing they found is that she had a middle uterine atery bleed. She bled into her broad ligament and it stayed contained in there. If the ligament had burst she would have bled to death during foaling.

Now I know for sure that I made the right decision.
 

Rusti
Breeding Stock
Username: Rusti

Post Number: 358
Registered: 12-2008
Posted on Wednesday, May 20, 2009 - 05:11 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Susannah I'm very sorry for your loss...I had been praying for your mare, but I'm glad she is not hurting anymore. She was very lucky to have you.



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