# Sunken flanks, but fat



## Selaya (Feb 24, 2013)

Puzzle of a liftime, I suppose. So I come here to see if anyone has seen/knows this/has suggestions!

I've owned my mare for four years, give or take, but I've been her only rider for 6 years. Man, time goes fast. Anyway, since she's had bloodworms (or red worms, I think it's in the UK) and she went through a whole ordeal with the vet, things weren't looking great. She'd lost every muscle tone she ever had, and she was a straight up bomb. From sport horse to bony shambles in a few weeks' time. Now, after worming her religiously (even in her blood, as desperation took hold) she started looking better and feeling better. But where other muscle came back and her fat built up exponentially, she's never regained anything in her flanks. Vets have told me a multitude of things, from "She's not worked well" to "Well, she's fat and that's the problem", or even "She's too thin". Now, that last one is absolute bull, that I know.

The sunken flanks just will not get better, though. She's on strip grazing because she gains weight like she wrecks things (which means she's feeling fine, but it's often, and a lot). If I put her on full grazing, she's laminitic within a week or two. She's "slightly" allergic to dust and/or pollen, but the clinic wasn't sure and tests didn't really show a big allergy. It shouldn't explain the flanks or her inability to calm her breathing on a heavier ride. Her lungs were triple-checked and she's even not IR, even though she has a pretty hard neck. Magnesium doesn't work for her. She doesn't have any shortages, not even Vit E or selenium. Clinically, nothing should be wrong. Yet here we are with the flanks looking like she'll pass out any minute now.
She's been rugged since this weekend, since 1) I was sick of cleaning her up during the torrential rain and 2) she's stubborn and she does not and will not come in to her shelter when it's raining nonstop, which results in tight back muscles.

She apparently has ongoing glandular ulcer issues, which are very uncommon here. She pees, eats, poops well, though her poop doesn't look as hard and round as I'd like it to be. Standard ulcer medication (for two darn years) didn't do anything for her. No sucralfate, no omeprazole, not even a combination of both.

She's now on "living yeast" and chopped grass in the evenings (max. 100gr of that + 15 gr of yeast) and her poop got a little better, but her flanks still tire me out.

She works six days out of seven in the week, of which two days are lunging or plain ol' walking around the neighborhood. The other days are 15 km rides or more, but with her breathing as if she's about to keel over after a hill, I don't dare putting more kms in. She's not even breathing like a horse that's out of breath would breathe - she's breathing fast, but without a sound. As if she's just breathing like mad and her flanks sink a little deeper, but it's not like a horse that's having a fit or a horse clearly unknown to the workload. She doesn't breathe louder at all. Doesn't squeak. Doesn't start blowing. 

Sorry for this jumbled explanation, but here we are. It's been a jumbled up few years of this.:???:

First photo is how she looks half of the time, second is how she looks when her flanks have a fit.








https://ibb.co/brGmCNV








https://ibb.co/wsJxV94


----------



## AtokaGhosthorse (Oct 17, 2016)

Looks normal to me, but in the picture it's hard to tell if that's a trick of the sun plus her color on her flanks or what.


----------



## Kalraii (Jul 28, 2015)

This is interesting so want to follow for replies. I'm just comparing it to myself (running) when I get bad cramps and struggle. You sure she's well hydrated and got a good balance of electrolytes? You add any salt to her feed?


----------



## AtokaGhosthorse (Oct 17, 2016)

Kalraii said:


> This is interesting so want to follow for replies. I'm just comparing it to myself (running) when I get bad cramps and struggle. You sure she's well hydrated and got a good balance of electrolytes? You add any salt to her feed?



I had a big long reply typed out and deleted it in favor of my previous one.

Here, if our horses sweat out on the trail or in a pen, whatever, we call it* sucked up*.

You'll hear: Hey man - your horse is sucked up. Bad. They need water... (And salt, etc)

Means the horse is dehydrated for whatever reason. The flanks are the first to sink in and show the most change, IMO.


----------



## Selaya (Feb 24, 2013)

It's not a trick of the sun, it seems that way on a photo, but I assure you it's not. I can put my hand in that hollow there, behind her ribs. 

Kalraii, she drinks often and pees a lot. Always has very clear pee and they have several kinds of salt blocks around their pasture. They seem to like the added mineral (processed) ones best, after that the normal white ones, and then the himalaya ones. She eats at them a lot, so I imagine she's getting enough... the skin test shows nothing, everything jumps back very quickly. What salt should I give then, added to what they already have?

AtokaGhostHorse, I've heard the term before, but can this happen with four salt licks around that are regularly used?


----------



## horselovinguy (Oct 1, 2013)

Your horse is far from thin...









Heaves, COPD....
I think I see a hint of the abdominal line the horses develop not because they can't inhale, but they can't exhale.
This is a cumulative affliction, getting worse over time, in certain weather conditions flare-ups occur but the damage and scarring of the lungs is permanent.

My other thought is if you had bloodworms...truly in the bloodstream did they attack the lung tissue and cause damage?
They are known to attack the organs, the lungs being one of them.
How you would find that out I am unsure...

How long did you treat for them?
With what and are you still under the vets watchful directions for continued support and drugs administered?
This is not something that is finished and gone in a few weeks...this is months of diligent follow-up and then ongoing testing.
Reinfection to a horse who was compromised is just to easy to happen...
Do not let your guard down.

I'm sorry...
I know you say you are riding the horse 6 days a week but she has near nothing for muscle anyplace and a hanging gut..the tiniest bit of muscle in her shoulder but she should have more.
She looks bloated to me...
Is it a worm-bloat is what goes through my mind.
For a horse who is ridden, even at a walk 6 days a week for 15km = 9 miles something_ is very wrong!_
That horse_* should*_ have muscle-tone and sculpting, _not_ what is seen in your pictures.
Much does not add up for your horses condition...

:runninghorse2:...
_jmo..._


----------



## Kalraii (Jul 28, 2015)

@Selaya if she eats them a lot its maybe coz shes not getting enough of something specific or simply just not enough. Would just be easier to add in x spoonfuls for her than to be licking at a block for hours at time, esp if having a good workload. Have you had her grass/hay tested as well and her feed? If my mare began showing symptoms of things like this it'd be one thing I'd crack down hard on first!

edit: horselovinguy and I posted same time and she has extremly valid points. I forget the km to mile conversion. My mare gets ridden 40mins a day, with a hand walk too. At that time she was being ridden 3-4x a week only and developed more muscle than your mare. I do wonder where the intake of nutrition/electrolytes is going wrong in helping muscle development etc... defo things to think about.


----------



## Selaya (Feb 24, 2013)

horselovinguy, very good post! She was infected (or started being very lethargic) in 2016-2017. Then it came on slow, starting with the flanks going a little sunken, but still on the same feed (at the time, she wasn't mine yet, and her previous owner fed her everything. I mean, everything. Five feed beets a day, 2 Ha of grassland for herself, she was alone, got a kilo of oats a day plus old bread). She was severely overweight then, but she started losing her spirit. Then when 2017 turned to summer, she went down. Laid down and just didn't get up. I got a call from the people that lived next to the pasture that there was something wrong with her, and raced there. The owner of the other horse (and the one deciding the pastures) successfully peer-pressured me into not calling the vet, but after a day of her limping around, I did. The vet literally just said "Nothing wrong" and she looked like... well. Like this.

https://ibb.co/tMwMm9d

I had one vet after the other come in who just didn't believe me. I kept at it, but there was nothing. No warm spots, no icky places. Then she started getting very sensitive in the stomach area. Even now, push a little on her breast bone and you might lose your arm. Finally, after months, she got diagnosed with glandular ulcers because I forced the clinic to do the test. They didn't want to, at first. "Drafts don't have ulcers" they told me. Her blood was fine, nothing out of order. She's had more blood tests in two years than I, personally, have ever had for me. Nothing showed. No cushings, no IR, nothing. Still, there was a little "infection" going on in her blood, they said. Was she sick? They didn't know. She was put on antibiotics, but since they had no idea why she had some sort of infection, it may not have been the right kind. Nothing happened then. She had a lung scan. A camera in there. An ultrasound of her intestines and lungs. An x-ray, even. Nothing, nothing, nothing. Even her lungs seem to be in fine working order. A rectal exam didn't turn up anything either. There wasn't even slime in her lungs, and she was supposed to be slightly allergic. Some of the last vets even told me he was just going to give her a slime-dissolver anyway. Of course, no slime means that ain't working either. According to every test ever in the last years, she's supposed to be incredibly healthy, were it not for that little infection rate in her blood that she won't shake off. So no scarring, no damages, nothing. Yet here we are... She was wormed against bot flies, wormed with every bloody thing on the market, religiously, with 4-8 weeks in between depending on the product. 

I'm doing another poop exam soon. See if there's anything in there. Last time she turned up clear, once again. Third time this year.
I guess I just don't know anymore. Vets have been absolutely useless, the most common thing said being "But she'll never look like a warmblood, nothing wrong with her. Drafts just look weird"

Kalraii, Her hay showed a lot of sugar, but due to her allergy, which makes the flanks ten times worse and gets her coughing (she never did before she was infected, by the way) I have to soak everything anyway. She hasn't been on hay for at least four months now, only grass. Grass can't really be tested here, though soil can, by farmers. It costs a hell of a lot, though. The only thing I know is that long grass seems to tide her over better than short grass does.

I'll look up what I can give her salt-wise!


----------



## QtrBel (May 31, 2012)

I see a very overweight horse that is likely struggling due to that heavy load. Add in her history and I'd say COPD could be an issue. The last picture you posted (most recent post) she still needs muscle but her weight is much better.


----------



## walkinthewalk (Jul 23, 2008)

If adequate wter is not an issue and yo know for sure she is drinking a good ten U.S. Gallons daily, either:

1. Enough damage has been done from the bloodworms that the flank area may never recover.

2. She is still dealing with front or hind gut ulcers or both.

2.1. To that end, if you're able to get this product and to spend more $$$, because it's expensive:

Egusin

I saw this recommended on another site -- the lady's vet had recommended it to her. It is all natural and does not need a prescription.

It is similar to Succeed but there are differences. I had my horse in Succeed for 90 days with no improvement.

2.2. He has been on the Egusun SLH six days and I do see improvement. 

2.2.1. He has already stopped biting and kicking at his stomach.
2.2.2. Most important, his manure has gone from a light black to a healthy brown - brown is good as he eats more gay than grass.

3. The SLH is powder and somehow we owners have to get nearly two full cups down the horse daily. My horse is IR so that's almost as much as he gets in Timothy pellets. Fortunately, my horse finds the SLH very tasty. He does not like slop, so I mix just enough water to hold everything together.

3.1 after 21 days of the SLH, the horse then goes in the 250 which is a pellet, for another 21 days.

***
OP, if you can get this product and your check book won't cry too much, I would suggest giving it a go, if you don't think the hard line and sunken flanks is COPD related, and you've tried everything else


----------



## Selaya (Feb 24, 2013)

Qtrbel, The last one was two years ago and she was literally skin and bones, *this* is what she looks like when she has muscle and she is at a correct weight for her.

https://ibb.co/BGhCt94

This was before bloodworms, she was still slightly allergic. COPD would require heaving, which she doesn't do. It would also require damage. There is none, according to the clinic and every test she had to go through. 
She only coughed during wintertime. This stopped after I moved her and she got hay in nets instead of above her head.


----------



## rambo99 (Nov 29, 2016)

She looks good in the last picture posted. First pics of her she looks fat and out of shape.

I see no sunken in flanks, I see a big fat belly though.


----------



## Selaya (Feb 24, 2013)

But that's the thing - She's not fat in the sense she could be. She's fat and doesn't build any muscle whatsoever. There ARE sunken flanks. There's a literal hole in them. Sometimes it's halfway full, sometimes it's empty. Absolute fact that we cannot get around is that she's not building muscle like she should, and she lacks muscle tone in both hind end (a lot there) and topline. This is not due to her being fat, trust me. I've known her for a good long while, and I've seen her morbidly obese. This is not what that is. When she was obese, she literally had at least half more of the muscle she has now.

I know this is digital and not everyone sees the same thing, but at least trust the OP. I know my horse, I know what I see, I know what I feel. There's a hole that should not be there, and muscles that should.


----------



## walkinthewalk (Jul 23, 2008)

I can clearly see the sunken flanks in the bottom picture, when I enlarge it.

Believe me, just the way you knowledgabley articulate the issues and treatments to-date ---I don't doubt you for a second

So here's another thought, given her past issues with obesity -- all of the stress could have triggered metabolic issues and also the very early stages of Cushing. High ACTH levels rarely show in the very early cushings stage.

IR and cushings can both cause muscle loss but cushings seems to be more the culprit. A horse does not need to have a splotchy or yak-looking coat to have a failing pituitary gland.


----------



## QtrBel (May 31, 2012)

The thing with pictures though is with equipment on you are missing a big part. Without them being lined up with the year tag and in a similar pose you don't catch the nuances as well. She looks pretty close to perfect in this last picture that you added so if that is where she started (and I am not doubting) then she has been through quite a bit of change over the years you document. I'd also suspect PSSM as possible.


----------



## Selaya (Feb 24, 2013)

Walkinthewalk, phew, okay! It might very well have, yet she's been tested four times for Cushing's. Every time her blood was checked, she was checked for that as well, including Lyme and that rat disease I keep forgetting the name of. Nothing was ever out of the ordinary for two years, wouldn't it get a little worse then? 

Qtrbel, yep, that was her before this show started. We were going to compete, she was at 50 km and counting that she could comfortably go. She's still so excited to be out and exploring new places, that I just owe it to her to keep looking until I find a solution. PSSM could be a factor, I presume, but I was told it doesn't add up with the infection and high beta-globulin in her blood? I'll be testing her after a homeopathic vet takes a look at her, though. After eight and more vets plus the clinic, I welcome any help with open arms.


----------



## QtrBel (May 31, 2012)

@Selaya The thing with PSSM is that IME it is something just hanging out in the background waiting for an excuse to make an appearance. There is typically some event that starts it off. You can have a horse with it that shows no signs until late teens, even later if everything in their life is idea then something stressful starts the cascade. You may not be looking at one thing causing this but different things together making up this result. Most people that see it earlier have made changes in feed or work load or added stressors that cause it to start. Those that you see it later have been essentially on the best diet for them, ideal lifestyle and stress free. I have one that the physical symptoms didn't show until her mid 20s. Then her team mate of 20 years died. It was caught early so the spiraling down hill was stopped but getting her back in shape is still not going to be easy as I have two others that had the physical start earlier for different reasons and they take work to keep them looking decent. Not perfect but decent. I won't get them back to where they were but if I can get them close and keep them there then it's worth it.


----------



## Cla2090 (Nov 5, 2019)

Sounds just like my horse!! I had read your previous posts, especially the one regarding "Lethargic" horse. I sent my horse's blood work to Pathogenes lab in Florida. Turned out he had a rare neurological disorder called "Polyneuritis Equii". Very much like MS in people, where the myelin is damaged around the nerve sheath in the peripheral nervous system (not in the central nervous system). I was concerned about EPM, but it was an all-over the body peripherally, kind of problem. Weakness and ataxia, I knew he had a serious problem, but no vet could find an answer so resorted to saying he was just aging poorly. I've had him for 21 years (since he was 20 months old) so I knew him well! He would allow me on, and try to do his job for me, but I wasn't comfortable, I felt he was in distress/pain. He also had ataxia, weak tail pull, etc. He is on the medication from Pathogenes Lab now. I will try to remember to update, because if your horse has this same issue, it will not improve on its own! You will need the meds. One other thing to note was the very low vitamin E levels. Nearly to zero! So supplement natural Vitamin E as well if needed. If your horse has this issue, the low E level will show on the blood work.**


----------



## Cla2090 (Nov 5, 2019)

Selaya, I'm not sure how to get to your other posts about this horse because I am new to this forum, but it is suspected that inflammation from allergies may be one of the causes of the Polyneuritis Equi that I mentioned above. I believe that was the case with my horse. Just for some background, my horse was an eventor/cross country type. I never rode him into the ground, he was never lame in his life until recently. All of a sudden he had abscesses in all hooves, it was a train wreck, he could barely walk, and due to severe ataxia, we were very wary of even entering the stall with him. It was that bad. Along with that, a weak tail pull and I could tell he was depressed all the time, and also felt he was in some sort of allover pain. I'm so glad I got back to a post that was more recent that I could respond to. I believed I would lose my horse and felt that whatever was going on with him was killing him, and found out I was correct. Polyneuritis Equi leads to a slow death due to the complications it causes. Luckily it is entirely treatable and CURABLE! but just recently! Here is a link to the lab that tests and developed the medication for this horrible neurological disease. They will need your vet's assessment if possible, but will allow you to fill out the paper work, and send the blood samples yourself. They will also tell you the diagnosis, or you can refer them to your vet so that they can explain treatment, monitor your horse, etc.
Here is a link to more information: https://pathogenes.com/w/polyneuritis-equi/
Best of everything to you and your horse! Please let me know what happens.


----------



## Cla2090 (Nov 5, 2019)

*@Selaya*



Selaya said:


> Walkinthewalk, phew, okay! It might very well have, yet she's been tested four times for Cushing's. Every time her blood was checked, she was checked for that as well, including Lyme and that rat disease I keep forgetting the name of. Nothing was ever out of the ordinary for two years, wouldn't it get a little worse then?
> 
> Qtrbel, yep, that was her before this show started. We were going to compete, she was at 50 km and counting that she could comfortably go. She's still so excited to be out and exploring new places, that I just owe it to her to keep looking until I find a solution. PSSM could be a factor, I presume, but I was told it doesn't add up with the infection and high beta-globulin in her blood? I'll be testing her after a homeopathic vet takes a look at her, though. After eight and more vets plus the clinic, I welcome any help with open arms.[/QUOT
> Please take a look at the responses. Not sure how best to notify you of the information I posted today. @Selaya


----------



## QtrBel (May 31, 2012)

Has that lab and the medications they dispense been cleared by the FDA? There were issues with compliance that made our news a couple of years ago.


----------



## Selaya (Feb 24, 2013)

It's been a while, but thought I'd update for those with the same issues.

Went to a 'world-renowned' clinic, Equitom, but after two weeks of staying there and a lot of money, they just found a ragwort poisoning and due to complications with the biopsy she also went through Peritonitis, so an infection of the membrane that lines the intestinal wall. She got better within days for that, so I'm assuming I just have a really, really stubborn horse  I got her home the same or worse than I left her there - flanks even more sunken. She got Sedochol to get the toxins out, but she's still cramping and her flanks still look terrible. I had her scoped as well, and there were no ulcers present. 

The vets at the clinic were extremely dismissive of her flanks. So not a good experience overall. She was also pretty much stabled 24/7 and they were surprised that she tried to escape several times. 

She's on milk thistle right now to see if it helps any. When she's eating though, I can't really see the flanks dropping. She cramps her stomach together very clearly though. Her lungs are still perfect on camera.


----------



## walkinthewalk (Jul 23, 2008)

You have been busy spending money.

If the traditional vets are shrugging their shoulders, I would try and locate a vet well schooled in Chinese medicine and herbs — it seems like you’ve got nothing to lose at this point

My equine chiropractor is a holistic vet and has studied Chinese medicine for 20+ years. She has fixed my horses a handful of times, thru the years, when more than one traditional vet shrugged their shoulders.

Thank you for updating. I hope you can get her back to normal, she sure is pretty


----------



## Selaya (Feb 24, 2013)

That's about right ...  

Update - brought a respected homeopath in, but it brought us nearly nothing. Instead of being against grains, he said I was 'giving my horses poison' because I fed them agrobs. I mean, for real? She is getting spelt now in small dosages and seemed to be doing better on that for quite a while, but she's also on extra protein for her muscles. She did have a cough that got worse, and then my shetlander started coughing too, and then the emergency vet had to come out for him. A bacterial infection. They're now on Ventolin and flixotide, my shetty's getting antibiotics and both of them are on mucous thinners (no Idea what the proper name for that is). She's getting very sunken flanks again, though... It was pretty good lately, but now she's a little slow and seems a bit depressed. Lots of gross yellow snot coming out of her nose too, my shetland seems to be having less and less of it luckily. #cantcatchabreak


----------



## jaydee (May 10, 2012)

Thank you for updating your thread.

Have you ever re-checked the problem she had with redworm/small strongyles?

They have a life stage as encysted cyathostomin larvae in the walls of the large intestine, where they can remain for a surprisingly long time before emerging. 
They can cause a lot of damage to the walls of the intestine while encysted and when they emerge. 
For some reason, that hollow flanked look seems to be typical of horses that have them or have the after effects of them.

They don't show up in a fecal test but a blood test has been available since 2019 - link to a UK site
Small redworm blood test (including encysted larvae) to be launched as a diagnostic service in September 2019 | Veterinary Practice (veterinary-practice.com) 

At present the only effective products on the market that will deal with the encysted small strongyles (redworm) is one that contains Moxidectin as the active ingredient.
It works best if combined with daily removal of manure from the paddocks


----------



## Selaya (Feb 24, 2013)

Jaydee, went ahead and got a fecal test done (as so far the fecal here has always worked to find them) and she does have a redworm infection, albeit a small one, together with my Shetland. She's on 250, he's on 200. The lab works together with vets and will send me over the appropriate dewormer! 

Even with collecting all the poop religiously for years, it's still such a mess to get rid of these worms.

I've also sent the info to my vet as her flanks have continued to drop more, but she's the type to think it's all in my head and I should just make her lose some weight now. 

Maybe I could still try bo yea sacc from Audevard...


----------



## Selaya (Feb 24, 2013)

So since this topic will never end (sadly, vets are either stumped or prone to lying to my face) - here's another update.

She's been doing bad again. Very. It was all fine and dandy over the course of summer, but now that autumn's coming all has gone to... Well. Yeah. Her flanks are completely sunken in, she stands awkwardly, and she refuses to eat the grass I serve her. Absolutely refuses. I need to mow the grass again because she completely refuses to touch it. I'll make sure to give it a boost of cow manure this year instead of compost. I don't know what happens to the grass during September, but it's a hellish month for her, apparently. Suddenly the prissy little thing starts starving herself. 
I'm really, really sick of it, but vets are useless to it, they have no clue what's going on, and no tests give any more information. I'd know, she's done them all.

She's now on 250 gr of Pink Mash and 250 gr of body builder (local feed, with a good deal of protein). 

Any ideas?


----------



## gottatrot (Jan 9, 2011)

My thoughts are that this may not be a diet or infectious issue. I am seeing muscle development in the flank that looks like it is from spasm type activity. 

She is a draft, so things like shivers and pssm come to mind. Things that get better over the summer when fresh greenery boosts vitamin e levels may relate to neuromuscular problems that use extra e. Because horses use the e stored in their bodies, putting it into the bloodstream, they can test normal even when having issues that are using up their stores. If you haven't tried giving high dose e (3,000 iu or so), it might be worth trying to see if the spasms improve.

I'd like to see her being lunged. Can she go in small circles, can she back easily, do her hind legs reach up unrestricted? Because I could also see that muscle development happening from something like a stifle issue where she is compensating for hind end weakness. If she has any movement issues, and is getting lots of exercise, she will be using extra e, magnesium and selenium. 

All of those are needed for neuromuscular function. So another solution could be a daily pain medication trial of Equioxx. If she is ending up with muscle spasms, the pain could be taking away her appetite.

I'll assume you have evaluated her tack, and cannot correlate any increase in activity in a certain saddle or rider with possible spasms or pain.


----------

