Chasing Pavements

I have been mulling over the writing of this blog post for a while now.  As I turned on the radio and sat down to start writing, the Adele song, "Chasing Pavements" came on.  The lyrics are quite fitting to the the questions circling me right now.  "Should I give up, or should I just keep chasing pavements?"

I am facing some tough decisions on several fronts.  I know I am fortunate - I have a supportive husband who allows me to reach for my dreams.  I have roof over my head, food on my plate every night.  I have cars to drive, horses to ride, and pets to love. I have some tough decisions ahead of me, and it is better than facing a difficult future without the ability to make those decisions, but they are still tough. 

A sweet tabby face and chirpy meow greets me whenever I open my basement door.  Bob, the one-time barn cat who adopted me last fall, always has a cheerful greeting for visitors familiar and unfamiliar despite the FIV that has torn down his immune system and allowed giardia to ravage his innards.  Treatment only eases his symptoms briefly, before the raging diarrhea resumes.  We have exhausted his treatment options.  He is incontinent and I am constantly cleaning up his accidents throughout my basement.  It's a disgusting and constant mess, but I can't be too unhappy about it when he still so cheerful, chirping and purring as he bounds to meet me, though his digestive tract must give him constant suffering.  I know that I'm going to have to make that decision pretty soon, though.  His condition is terminal, and it will fully overcome his body and his cheery outlook.  Though he keeps chasing pavements (and my ankles), I will have to give up for him.  All I can do is make his last weeks on earth happy ones, but I hate knowing that his life will have to end at my hands. 

Larry and I have been chasing pavements of our own.  He is a beautiful horse, well-built, sensible in new surroundings, calm but curious, and full of personality.  He is so close to being just what I wanted in another show horse.  But I guess there's always a catch. For Larry, it is his headshaking syndrome - the neural condition that causes him to involuntarily jerk and twitch his head.  I've researched the condition, delved into his past, and analyzed his present.  I've tried nose nets, fly masks, every bit and non-bit in my tack trunk, different (and no) tack, different riding and training tactics.  I've ridden in near darkness and in blazing sunlight.  I've dosed him with melatonin and dexamethasone.  I've cried, yelled, whispered, and begged.  I can reduce his episodes via the nose net, fly mask, and/or melatonin but cannot eliminate them.  Weaning him off of the melatonin and onto the dex made me realize that the melatonin did more for him than I initially thought, but the dex did nothing.  Somehow, his great Standardbred nature has shown through the HSS complications and he's progressed under saddle - he now backs readily with the softest of bit pressure, moves off leg and seat pressure, bends around his corners, yields his hindquarters and forehand on command, drags a rattling jug of nails off his back, and pushes boldly through a curtain of water noodles, but he'll never be able to hold a consistent frame or go like a show pleasure horse with his involuntary head flip. 

I want so much for him to be my perfect show horse, but I think the time has come to realize his path and mine are not compatible.  I want to dabble in lots of disciplines - jump, do dressage, ride bareback, go western, and push the horizons of the Standardbred in the show ring.  With appropriate management, he is certainly rideable and capable of pleasure riding and the occasional fun show (where the equipment he wears and how he holds his head aren't so critical), but I think the type and amount of showing that I want to do isn't fair to him.  I can't show with a fly mask, using the nose net is contentious beyond all but the lowest levels of pleasure shows and is prohibited outright in dressage competition.  Even if there had been a pharmaceutical answer, I still would have misgivings about the consequences of medicating him forever.  I don't think I'll ever feel comfortable jumping him when an ill-timed head flip could have dangerous consequences for us both. 

I now face the reluctant task of finding him a home that meets his needs.  I had hoped to do several more shows with him this season, optimistic that I would have found a way to make us work.  I will finish out the show season as best I can; there are several smaller saddle club shows where there may just be a saddle club member looking for a beautiful horse to trail ride and do a few small shows with.  Somewhere out there is just the right home for him, and I hope, somewhere out there, is just the right new Standardbred for me.  We start these blogs hoping they will become the chronicles for future greatness - stories of a journey to the summit of some great peak.  I guess this one is just the tale of chasing pavement that didn't lead where I hoped it would. 

Back to the Lab, Watson.

Lar had his date with the vet this morning.  I am thrilled that my favorite vet chose to return to KY after spending much of this year at a practice in Colorado, and happier still that he's had some success with headshaking cases previously.  He confirmed my observations and Lar's video clips as headshaking. syndrome.  General physical examination and ocular and facial examination didn't reveal anything significant, though while taking heart rate, Lar's heart rate shot up rapidly from 40 to 65 bpm before easing back to 40 bpm.  (Possible link to his training anxiety?)  The modern age of computers, video, etc. sure makes things a lot easier, as this entire week has been too dreary, cold, and rainy to ride or put Lar on the lunge line.  In Lar's case, the vet thought allergies seemed like the most likely trigger.  He's had luck with twice daily cyproheptadine, an anti-serotinergic and anti-cholinergic allergy medication.  I asked about testing for specific allergens, but he thought it would be very difficult to isolate a specific trigger allergen (not to mention then trying to eliminate it from the environment if it's something common like grass or tree pollen!).

Scientific Content Alert - avoid the next two paragraphs if you're not interested in the underlying science!  Serotonin acts as a neurotransmitter in the body.  It is linked with feelings of happiness and well-being; many antidepressants are targetted towards promoting it, and some illegal drugs act by making its levels spike in the body.  It also participates in the process of blood clotting.  It causes vasoconstriction, and quantities of it in the body can pain sensations (for example, wasps and some snakes inject it into their prey when they sting or bite).  Acetylcholine is a generally excitatory neurotransmitter in the body that acts presynaptically in the sympathetic nervous system and pre and post synaptically in the parasympathetic nervous system.  (It's pretty convenient that I've concurrently been studying some of these topics in my anatomy and physiology class.)  It seems logical that cypro could be effective in some headshakers by reducing symptoms associated with allergic response and/or excesses of these neurotransmitters.

The downsides are that it generally requires twice daily administration (in less severe cases, it may be reduced to once daily administration) at a cost of a few dollars a day.  It is also prohibited by most horse show sanctioning bodies, so horses must be taken off of it several days prior to competing (meaning that their symptoms may start to return just when you really need them to be on their best behavior).  Its efficacy can be hit or miss in headshakers, but my vet has had a personal success with it rate higher than the average, perhaps because KY is such an allergen riddled region.  Another treatment option is pulse dosing with dexamethasone, a steroidal antiinflammatory and immunosuppressant agent.  Allergies are basically the overreaction of the immune system to benign agents, so that coupled with mediation of inflammatory response explains the probable course of action in headshakers.  With long-term administration, immunosuppression, weight gain, and GI upset can be a problem.  The accepted course of treatment with the dex pulse therapy is to administer a fairly high dose for three consecutive days, then repeat every three to four weeks.  This relieves most of the risks associated with long term administration and (with proper planning) doesn't require mandatory cessation of treatment prior to sanctioned competitions.

So the current plan is to discontinue the melatonin (which didn't seem to do anything for him) and try the dexamethasone as both a diagnostic tool and treatment.  If it works, there's a decent chance that the cypro will also work if I need to alternate or change medications.

 I still wonder about headshaking being the root cause of all of his issues, as he does have some ability to suppress (but not eliminate) his behaviors when you really get after him (as I had to last week after he nearly pitched me while having a particularly bad episode).  I have no doubt the physical component is real.  The better questions are (1) can it be suppressed? (hence all of the neural experiments and pharmacology) and (2) can he be happy and comfortable doing what I want him to do?  Ultimately, the answer may be a combination of physical and behavioral, and it's quite possible that the life of showing I want to pursue with him may not be the best route for him.  

Better living through pharmacology?  I hope the answer lies at the bottom of the dose syringe. but only time (and more experimentation) will tell...