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  Discussion on Suspensory Ligament diagnosis
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New Member:
Caymie

Posted on Wednesday, Jan 15, 2003 - 4:41 pm:

Dr. O.,
My horse has just recently been diagnosed with his third suspensory strain. They do not think there is a tear, but will ultrasound it to make sure.
My question is this: is it possible for a low grade suspensory problem to cause the horse soreness for awhile before he actually shows lameness in his gait? Could it have been bothering him for a couple of weeks prior to the actual diagnosis?
Moderator:
DrO

Posted on Thursday, Jan 16, 2003 - 6:10 am:

Hello Mary and welcome,
I am not sure I understand your questions. How do you know the horse is sore if he is not lame? Certainly it could bother him prior to the diagnosis.

With mild strains, this can be a hard one to make on just physical inspection and prior to nerve blocks but the diagnosis is straight forward.
DrO
Member:
Caymie

Posted on Thursday, Jan 16, 2003 - 8:49 am:

Dr. O.,
He was in fact lame on Monday, (head bobbing lame)
and the vet came out on Tuesday, did the nerve blocks and determined it was his right front suspensory. Since he has had a history of trouble with this right suspensory, I was just wondering if it is possible that there had been a low grade soreness there for a couple of weeks prior to turning up lame. His behavior was such that I thought his leg might be bothering him again and he would shuffle at the trot, like he was trying to break into the canter because it hurt at the trot. So, is it possible that his suspensory was sore for a period of time prior to his exhibiting the lameness? Thank you.
Moderator:
DrO

Posted on Thursday, Jan 16, 2003 - 11:22 am:

Perhaps Mary,
But the answer depends on the horses personality and your ability to determine mild lameness. Some horse will attempt to perform inspite of remarkable lameness, some don't need any excuse at all to perform poorly.
DrO
Member:
Caymie

Posted on Thursday, Jan 16, 2003 - 3:21 pm:

Dr. O.,
Thanks for your reply. My horse always lets me know when something is bothering him. A couple of weeks prior to actually turning up lame, I felt as though he was not quite right again, (and this is a feeling I am well aware of as this is his third suspensory injury). He still tried really hard in our jumping lesson because that is what he enjoys doing, but he did not feel quite right on the flat. However, since he did not appear to be off in his gait, (and I had two vets observe him), I kept riding. Therefore, I was just wondering if I was imagining the whole thing over the past few weeks, or if he could have been a little sore even before he turned up lame. His last injury to this same area was in October, and I don't wonder if it had not completely healed from that episode.
Member:
Caymie

Posted on Thursday, Jan 16, 2003 - 6:47 pm:

Dr. O.,
Also, I meant to ask you what type of shoe you would recommend for a horse prone to suspensory injury. My horse carries about 1450 pounds on a 16.2 hand frame, he is massively built, even for a warmblood. He has been in regular steel shoes with clips (for jumping) up until now. I would guess my options might be a bar shoe or some type of aluminum wedge? Thanks.
Moderator:
DrO

Posted on Friday, Jan 17, 2003 - 7:10 am:

I would maintain a normal aligned hoof-pastern angle Mary, whether this requires wedges or not. I would shorten the toe in front to ease tension at breakover and if possible rocker it also. Some have recommended increasing the angle of the hoof 2 or 3 degrees but I prefer to keep it normal. Perhaps I would try the increased angle if the problem is recurrent... like yours. DrO
Member:
Caymie

Posted on Thursday, Jan 23, 2003 - 1:05 am:

Dr. O.,
What is your opinion on trying my horse with an egg bar shoe vs. an aluminum wedge for a recurring suspensory strain? He is a 1450, 16.2 hand warmblood. What would be the pros and cons of each? Thanks.
Mary
Moderator:
DrO

Posted on Friday, Jan 24, 2003 - 7:22 am:

When talking about your horse, the recommendation has to be made after examining the horses conformation. However, in general, the answer depends on what his angles would be with and without the wedge and my previous post covers my recommendation.

In general I would not recommend either raising the angles above normal or a eggbar. Both have been shown in carefully done research (Equine Vet J 1996 Mar; Influence of shoeing on ground reaction forces and tendon strains in the forelimbs of ponies.) to increase the stress on the suspensory, at least in some horses under some conditions. They are both traditional treatments that have been associated with success but it looks like the sucess was in spite of the change not because of it.
DrO
Member:
Caymie

Posted on Tuesday, Mar 18, 2003 - 9:41 pm:

Dr. O,
Well, I am back again with more questions. My aforementioned horse was diagnosed with a suspensory strain in the middle of January. He was started back to work about 4-5 weeks after being on rest in his stall with a paddock and hand walking. For his past two shoeings he has been shod in an eggbar wedge shoe, due to his heels being extremely underrun. He is starting to exhibit some of the same behavior he did prior to his last injury (which was his third, and by far the worst injury to his suspensory, this has been going on over the course of the past two years).
He is hopping off of his right front foot(the leg in question) at the trot, he will try and stride out for a couple of strides and then hop off of it like it hurts. He is also very resistant to turning to the right. A friend whose opinion I trust also told me that it looks like his right fetlock might be DrOpping a bit more than the left. I can't say for sure, since I was riding him at the time.He looks a little stiff when you first lounge him, but is not overtly lame (yet). My questions are these:

He was not ultrasounded before being put back to work. Should I have an ultrasound done now before I continue to increase his work? Is it possible he needs more time off? How long does a mild/moderate suspensory strain usually take to heal? I am guessing it was more in the moderate category because he looked almost three legged lame.

Is it possible that we are missing something? I am starting to wonder if there isn't a problem in his foot. Should I have that examined as well? He has had long toe/low heels for the better part of two years due to some improper shoeing. His heels are just now starting to grow back.

He has never exhibited this behavior under saddle before except for about 2-3 weeks prior to his last suspensory injury, when he turned up head bobbing lame.

Thank you,
Mary
Moderator:
DrO

Posted on Wednesday, Mar 19, 2003 - 6:28 am:

I have had moderate suspensory strains take up to 9 months to heal Mary. Your other questions are all judgement calls that should be answered by someone who has/can examine the horse.
DrO
Member:
Cara2

Posted on Wednesday, Mar 19, 2003 - 8:38 am:

Hello Mary, my friends eventer did his suspensory in three places 5 years ago and he was out of work for 12 months. Even now it flares up for a week if he canters on anything harder than grass or an arena. Sorry I can't be more positive than that.
Member:
Aannk

Posted on Wednesday, Mar 19, 2003 - 10:58 am:

Mary,
My horse had a slight strain, no visible ultrasound abnormalities on the suspensory, and we gave him 3 months off totally, starting with stall rest for 45 days, then hand walking, then turn out, then 6 months to come back into cantering. He is just starting jumping now, his 9th month since showing any sign of lameness (it was a grade 1). So, I would have to agree that it is way too soon to be doing any hard work with this horse.
Member:
Caymie

Posted on Wednesday, Mar 19, 2003 - 2:24 pm:

Hi Alicia,
That's what I am wondering too-if he doesn't need more time off. I think that may be why he is showing some of the same symptoms again.This has been very frustrating, but he is only seven (soon to be eight), and I am not ready to give up on doing at least some Dressage with him. We were doing jumping, but I just don't think we should continue that for now given the struggle he's been having with this. Did you ultrasound your horse before returning him to work? If not, how did you know he was ready to start back to work? My horse was never on stall rest either, he was allowed access to his small paddock. Did you use any other types of therapies? Did you give him any bute? What kind of horse do you have and what kind of shoes does he wear? I think that Caymann's lameness was worse than a grade 1 because he was head bobbing lame, almost three legged lame. The vet said it was a strain on the ultrasound-no tearing of the fibers but stretching. He was using a field ultrasound unit though, and I am thinking that I need to take him in to the hospital and have an ultrasound done there. Thanks so much for all of your input.
Mary
Member:
Aannk

Posted on Wednesday, Mar 19, 2003 - 2:49 pm:

Mary,
I would definately give him more time off. I used Dr. O's rehabilitating injuries article. My gelding lameness manifested as him not stretching out his left front as much as the right going in small trot circles to the left, which was his only sign of discomfort. I have learned to take small signs of discomfort seriously with him, though, as he had a broken cannon bone for a month before I realized it (we were jumping on it, and he always seemed to land going one direction, I got him x rayed, and they diagnosed a green stick fracuture) when he was 3. I had my horse ultrasounded several times through the healing process, though nothing ever showed up on it, even from the start. We just ruled out enough to make an assumption that that was what it was, and we figured the rest and rehab would probably also help anything else that may have been wrong. My horse was on stall rest for 45 days. I just started by hand walking, then walking under saddle for a month, then adding in trot, etc. See Dr. O's article, it explains it all. I didn't give him bute or any other medication. I have a warmblood (Dutch crossed with anglo arab). He doesn't wear shoes, he's got great feet. Yes, head bobbing is way worse than grade one. The hospital ultrasounds are better, but if you can see something on the ultrasound, you shouldn't be riding, from what I can see.
Hope this helped!
Alicia
Member:
Caymie

Posted on Wednesday, Mar 19, 2003 - 4:42 pm:

Alicia,
Thanks so much-it helped a lot. Caymann is a 1400 pound, 16.2 hand Holsteiner, even when fit, he is just a massively built animal. I think this is part of the challenge in keeping him sound. My horse sounds very similar to yours in the sense that it's the small things that indicate there is a problem. Only because I know him so well. He is very dramatic, and if in the slightest discomfort, he will let me know long before he turns up lame. When I try to trot him he tries to stride out normally for a couple of steps and then hops off his right front foot. (The right front is the limb he has had the suspensory problem). He does this repeatedly throughout our ride, it's like hopping around on a rabbit, and he doesn't warm out of it. And I can't get him to turn to the right for anything. The ONLY other time he has exhibited this strange behavior at the trot is about two to three weeks prior to his last suspensory injury, which was by far the worst. He also doesn't want to go on the bit much. He also looks a little stiff when you first start working him, which from what I understand can be a sign of early suspensory injury. Today when I picked up his right foot to pick it out he almost went down on all fours. I think he is sore again. So, I am having the vet look at him on Friday, and I have made an appointment to take him into the vet hospital on Monday for another ultrasound. I just want to make sure we aren't missing something before we proceed. I'm pretty sure it's still his suspensory though. I am confused as to why if the vet originally saw a "strain" on the ultrasound, he didn't think it was necessary to re-ultrasound him before he went back to work. Can there still be incomplete healing of the ligament without an actual lameness showing up? I had thought so, but am not sure.

I will look up Dr. O's article on rehab. When you say you had him on stall rest, did he have access to a small paddock at first? If not, when did you start allowing that?

Thank you again-I'll keep you posted. Is your horse still doing well?
Mary
Member:
Caymie

Posted on Wednesday, Mar 19, 2003 - 4:49 pm:

Alicia,
I am having difficulty finding the article on rehabilitating injuries you recommended. Under what section is it? All I can find is a brief description of what the article discusses, but no acutal rehab protocol. Where should I go to find it?

Thanks,
Mary
Member:
Suzeb

Posted on Wednesday, Mar 19, 2003 - 8:57 pm:

Hello Mary,
I too have a horse with underrun heels and he used to have long toes. Have you had your horse radiographed to check out the internal hoof balance? If that is out of line, that can wreak havoc with tendons/ligaments etc. It is quite possible that with these hoof imbalances the suspensory ligament will always be prone to injury. May I suggest that you do not work your horse until you have a good vet/farrier team assess him and come up with a good shoeing/rehab plan. You will probably have to do a bit of research like you have been doing, but it will give you a good handle on what is going on with your horse and you will be able to question or challenge on how he is being treated. I hope this helps and keep us posted. Susan and Laser Bilsky
Member:
Caymie

Posted on Wednesday, Mar 19, 2003 - 9:51 pm:

Hi Susan,
Thanks for your reply. There is no doubt in my mind that the shoeing issue has contributed to our continued trouble with Caymann's suspensory. I started out with a farrier who was leaving his toe way too long, and his heels became very underrun.
So I took Caymann to the local veterinary teaching hospital where his shoeing was supervised by a surgeon. They took radiographs, and my farrier continued to work under the supervision of the equine surgeon. Part of their approach to the natural balance shoeing was to cut down his heels.
He was literally left without any heels. Decided that wasn't working, so I tried my regular vet's idea of the eggbar wedge shoe. Throughout the course of all of these various options, my horse has continued to strain his suspensory. But I am not sure how balanced his feet are right now. I am taking him back to the vet hospital on Monday to ultrasound his leg and I'm sure I will get yet another opinion on shoeing. I know that hoof balance is very important. It is just hard to know whose idea is the best. What type of shoeing worked for your horse? Thanks again-I'll let you know what happens. And I have no plans to continue working him until we have another look at this.
Mary and Caymann
Moderator:
DrO

Posted on Thursday, Mar 20, 2003 - 6:13 am:

Hello Mary,
That article you are looking for on rehab is at: » Equine Diseases » Lameness » Rehabilitating Injuries to the Tendons and Ligaments.
DrO
Member:
Caymie

Posted on Thursday, Mar 20, 2003 - 7:57 am:

Dr. O.,
Is it the same rehab protocol that is found under the article on flexor tendinitis?
Thanks,
Mary
Member:
Aannk

Posted on Thursday, Mar 20, 2003 - 9:02 am:

Mary,
Sorry I didn't get back to you sooner, this is a work account, so I don't have access to it all day.
Just to clarify, Guinness does NOT show pain at all. That is why I was jumping him on a broken leg. He seems to have a very high pain tolerance. That is why I worry when I see anything off.
Next, no, he did not have access to anything during that time. We kept him in for 45 days. He is good about that, however, as he was imprint trained and he likes people, so staying away from herd mates is not a problem for him.
Alicia
Member:
Aannk

Posted on Thursday, Mar 20, 2003 - 9:04 am:

Mary,
I forgot to mention, my horse is doing wonderfully. I jumped him for the first time since his injury last night, and he was perfect (only a small X, but I could tell he was very happy to be able to jump again, his daddy was a grand prix jumper, and he loves to jump).
Alicia
Member:
Caymie

Posted on Thursday, Mar 20, 2003 - 12:46 pm:

Alicia,
That's great that your horse is doing so well and jumping again. I hesitate to continue jumping for the forseeable future since Caymann has had so much trouble with this. The first step is to get him really, truly sound, and go from there. He is also not very good about stall rest, so I'm not sure what to do about that. We'll see what the vet says on Monday after we ultrasound him again.
Thanks,
Mary
Member:
Suzeb

Posted on Thursday, Mar 20, 2003 - 5:09 pm:

Hello Mary,
Laser had custom shoes made yesterday from 3/4 inch bar stock. They have a rockered toe in front and a heel wedge or elevation in the back to align his broken back hoof/pastern angle. Laser has done some jumping in his lifetime, but I think that is out of the question for a while if ever. He also has bone spavin in his hocks. Laser does not have suspensory injuries, but I do feel that the underrun heels are a contributing factor to the strain placed on his tendons and ligaments and his joints. He is also not very good about stall rest. He wants to turn in circles and dig a hole to China. Maybe you could have a stall neighbour next to Caymann or a small paddock outside where he could feel secure with a buddy or two that are able to visit over the fence. You might want to consider adjusting Caymann's diet if he has to rest for awhile. I hope this helps Mary and let us know how things turn out on Monday. Susan and Laser :-)
Member:
Caymie

Posted on Friday, Mar 21, 2003 - 8:35 am:

Thanks everyone for your suggestions and input. I will let you know what we find out next week.
Mary
Member:
Aannk

Posted on Friday, Mar 21, 2003 - 10:51 am:

Mary,
It seems you are doing everything you can. Just hang in there.
Good luck!!
Alicia
Member:
Caymie

Posted on Monday, Mar 24, 2003 - 10:18 pm:

Hi all,
Just wanted to give you an update on what the vet found. His diagnosis is that my horse has a big, giant attitude, (which I am well aware of:-)and needs to be put to work. He cannot find any indication that there is any lingering problem with his suspensory. He thinks alot of this is just behavioral, (largely the result of being off for a couple of months and having me catering to his every whim). My vet is a horseman as well, so I do trust his opinion. So, I guess we will proceed with working (on the flat only) and see if I can't get his work ethic back, and then see if some of this stuff stops. I'll keep you posted. Thanks so much for all of your suggestions and your help.
Mary
Moderator:
DrO

Posted on Tuesday, Mar 25, 2003 - 8:14 am:

oowwwww...makes my first/second post above look almost like I have a crystal ball.... I think I am getting readings from your horses mind " .....eeeany....meeeany....chili....beaannny...your...horse....is....about... to.....speak: Mary I don't want to work.....I want to eat grass....I want to eat grain...my buddies are not working as hard as I....and besides I was traumatized as a foal...." It is gone now. Any message for your horse Mary?
DrO
Member:
Caymie

Posted on Tuesday, Mar 25, 2003 - 8:46 am:

Dr. O.,
Gee, you and my vet should get together. Your above response (which was hilarious by the way),sounds alot like the lecture I got on Friday from my Texas born vet. After I stopped pouting I realized he is probably right, and Caymann is now on an overtime work schedule until his attitude gets to be a little more respectful/willing. The vet also told me that Caymann needs to stop thinking he is a "Priveliged Character" and start acting like a horse. At that point, I pretty much had nothing else to say.
Mary
Member:
Suzeb

Posted on Tuesday, Mar 25, 2003 - 10:32 am:

After cleaning coffee splatters off my computer monitor from laughing so hard am I able to reply to this. Laser (my little cupcake) is a lot like this. He would sooner act like a horse with his buddies than go to school and learn to behave like a gentleman. It is good to hear that "Caymie" is on the mend physically, but now he needs an attitude adjustment. What's the plan for that? I would still "Privilege" your "Character" with the best shoeing/balancing package that you can get and reward him for his good behavior. I am still giggling over this, but, I am laughing with you and not at you Mary:-)Let us know what kind of therapy the vet recommended to help Caymann get over being traumatised as a foal and being a "Privileged Character". Cheers Susan and Laser B.
Member:
Westks

Posted on Tuesday, Mar 25, 2003 - 11:46 am:

LOL ROFL :-)))) DR.O
Member:
Caymie

Posted on Tuesday, Mar 25, 2003 - 8:21 pm:

Hi Susan,
I'm glad everyone is getting some amusement out of this. Have you ever been lectured sternly by a Texan? My vet was so outraged with his behaviour he wanted to get on. I can just imagine it-Texas Quarter Horse roper vs. Holsteiner. Oh, my sides.

ANYWAY-to answer your question, Caymann already has the following therapies in place. Monthly Legend and Adequan injections. Special (and so inexpensive)aluminum eggbar wedge shoes, which we are slowly weaning him down from now that his heels are growing back. He gets a message every two weeks and acupuncture as needed from the aforementioned vet. He is on a billion dollar joint supplement called Cetyl-M, as well as vitamins, MSM, electrolytes, Horseshine and a Biotin supplement for his feet. He is also on a daily wormer. Let us not forget the specially fitted Dressage saddle for his sensitive back.
Stud Muffins, (his favorite treat) and carrots are offered and consumed daily. I have no idea why my vet thinks he is spoiled.

As far as his behavior goes, the vet thinks about a good month of hard, solid work ought to get his work ethic where is should be. (I won't tell you what his actual words were:-) I plan to work with him on the flat pretty rigorously, until he is respectful, cooperative and fit. Don't worry-I have always been very generous with rewarding him(part of the problem here), and I will continue to do so. We will go for trail rides and do some low level jumping as rewards for both of us. He is a great horse. We are working towards showing in Dressage at Training Level this summer.

As far as being traumatized as a foal, I think my little angel was actually traumatized from about age four to now. He had OCD in both his hocks and stifles, and had surgery shortly after I purchased him. Right after that he got very sick with equine influenza (fever of 107 and several days in the hospital, almost died) Then we began two years of on and off suspensory problems, with associated shoeing issues and back pain. Threw in a strained hock and stifle from getting cast, and a strained hock after attempting to flip himself over in the crossties, and he has had a busy past four years.
So, at times it has been a challenge for me to sort out what is pain related and what is behavioral. Trying to start a four year old warmblood with pain from OCD in four joints is an interesting experience. I am almost relieved at this point to have an actual non-physical explanation for his behavior.

I think the vet's recommendation for Caymann getting over being traumatized as a foal is for him to use Caymann to rope steer off of for a few days.

You guys are great-thanks for all the good input and comedy.

Mary
Member:
Suzym

Posted on Wednesday, Mar 26, 2003 - 10:41 am:

You all are too much! Thanks for the upper :-) Keep us posted on Caymann's progress, Mary.

P.S. I AM a Texan :-O

Suzy and Indy
Member:
Suzeb

Posted on Wednesday, Mar 26, 2003 - 11:33 am:

Hi Mary,
I have had stern lectures before, but never from a Texan. I would imagine it was quite animated. I'll say that you don't spoil Caymann at all, you just take very good care of him. Your dedication to nurse Caymann through his injuries and illnesses is really very admirable. Keep us posted on his "Manners" lessons. Susan and Laser
Member:
Caymie

Posted on Wednesday, Mar 26, 2003 - 11:51 am:

Hi Texan Suzy and non-Texan Susan,
No offense meant by the Texas reference. I love my vet, he is one of the main reasons we have been able to keep Caymann sound. He's one of the best equine vets I've ever known. Plus I get a kick out of his Texas style.

I'll keep you posted on our progress. What kind of horses are Indy and Laser? Where in Texas are you from Suzy?

Mary and Caymann
Member:
Suzeb

Posted on Wednesday, Mar 26, 2003 - 12:36 pm:

Hi Mary,
Laser is a 13year old, 15.3 hand, 1065lb Quarterhorse gelding. Your vet might like him but maybe not his manners. Laser is also Royally Privileged with Farrier's Formula, Massage Therapy, Acupuncture, Expensive but well fitting saddle, Hyaluronic acid I.V. injections and expensive, but extremely well made shoes and Oh yes, apples and carrots as treats in addition to his ration of good quality timothy hay. I always tell him I love him and when he is a "Good Boy" he gets that verbal reinforcement. Laser also has a very good equine vet. She is one of the reasons we have been able to keep Laser sound or at least as comfortable as possible. I have been to Texas once as my mother in law spends her winters down there and my English cousin also lives down there with her husband. Big and beautiful country. Cheers, Susan and Laser
Member:
Caymie

Posted on Wednesday, Mar 26, 2003 - 8:19 pm:

Susan and Laser,
Sounds like Laser is doing as well for himself as Caymann is. What type of riding do you do together? How long have you had him? I also have a quarter horse I bought this past September as a buddy for Caymann. He was a reiner and has impeccable manners. I keep hoping that some of it will rub off on Caymann, but Caymann is too busy bossing General around to take notice. I too have been to Texas a couple of times, it is definitely both of those things.

Mary and Caymann
Member:
Suzym

Posted on Thursday, Mar 27, 2003 - 11:46 am:

Oh, NO offense taken, Mary! :-) I considered it a compliment LOL!

I've lived in Indiana for the last 10 years, but I was born and raised in Dallas. VS Golden Desperado, aka Indy, is a 4 year old dark palomino Morgan gelding. And, as I'm sure DrO knows, I NEVER spoil MY horses - right DrO? :-O
Member:
Suzeb

Posted on Thursday, Mar 27, 2003 - 1:49 pm:

Hi Mary,
Laser is trail ridden and worked or schooled on the flat. He has mostly participated in Western endeavours. Laser is my daughter's horse and she rides him using a beautiful all purpose "English Saddle". At present, Laser has to many pathologies to be ridden competively so he is kept as a pleasure horse and wonderful companion. He is also considered a member of our family. Laser is also a very good herd boss. He is quite the gentleman about this and will not be mean to other horses, it is only when you take him out of this cozy environment that he can display bad behaviour. We have owned and loved Laser for 31/2 years and we are still learning about him. He has proven to be quite the loveable character that some people have attributed to being a difficult horse. Why don't you go into the training section on this site and read up on what Dr.O has to say as well as the other members. There is another treasure chest of info there as well. Good luck with Caymann Mary! :-) Susan and Laser B.
Member:
Caymie

Posted on Thursday, Mar 27, 2003 - 9:00 pm:

Susan,
Isn't it funny, what other people's perception of our horses can be? What one person finds unacceptable or annoying, someone else might find perfectly acceptable or not be bothered by it. Caymann has taught me more than any other horse I have ever known. I have tried to view our "training issues" as a challenge for me as a horseman, and an opportunity for both of us to learn. I will check out the training section as you suggested. I'm glad to hear that Laser found the right family for him:-)I think sometimes that is all it takes. Stay in touch!
Mary and Caymann
Member:
Caymie

Posted on Friday, Apr 11, 2003 - 10:23 am:

Hi,
Just wanted to update you all on my "Priveliged Character." (Caymann) These past few weeks he felt like he was getting worse and I did not belive that this was an attitude problem. Took him to a lameness surgeon (the one who did his OCD surgery) at the local teaching hospital yesterday. He is off on his left hind and right front. The surgeon believes that the soreness is in his foot and his left hind is off as a compensatory measure. Rads of hock. stifle, and navicular area are clean. Vet suspects soreness is soft tissue in the foot. We think we have caught it in time, we will know more on Monday when we do the ultrasound. So, I will be re-evaluating his shoeing. Anyone have any suggestions? He was put into an aluminum eggbar wedge about three months ago, that is when all this started getting worse. Thanks guys.
Mary

P.S. Don't worry, Caymann does still have his attitude. That's what makes him great.
Member:
Suzeb

Posted on Friday, Apr 11, 2003 - 11:49 am:

Hi Mary,
I was wondering how you were doing. Which soft tissue in the foot is the vet referring to and how did he arrive at that conclusion? Is this the same surgeon who works with your farrier? I am wondering if the eggbars are putting a little too much pressure in his heels/frogs. Laser did not respond all that well to Natural Balance Shoeing and I can't be certain if the farrier was not applying the principles correctly or if this wasn't really the thing to do. Laser is now wearing hand forged, 3/4" wedged steel bar stock on his front feet only and I must say he has improved dramatically. They have also been hot seated to alleviate sole pressure. They really are a work of art and I suppose Laser, royally privileged that he is will be asking for Italian Leather shoes next. Keep us posted. Susan B.
Moderator:
DrO

Posted on Friday, Apr 11, 2003 - 7:10 pm:

Susan is exactly right, this is a weird story or maybe we just don't have it all, but these were my thoughts: Caught what in time? He is going to ultrasound to localize the lameness to the foot? Whole body radiographs with no localization? And everytime I hear about a compensatory lameness, something nonexistant in my experience and which you do not see anything ever written about, I do roll my eyes.
DrO
Member:
Caymie

Posted on Saturday, Apr 12, 2003 - 12:15 am:

Dr. O and Susan,
No, this is not the same vet who was working with my farrier. This is a surgeon at the teaching hospital. He watched him go on the lounge line and under saddle. On the lounge the vet could see that he was off on his left hind. Under saddle he started doing that wierd hopping thing I have been describing. He acts like he always wants to canter, and acts like it hurts when he puts his right front foot down. They trotted him on the asphalt and he was obviously lame on his right front. They did the test where they put his foot on the block and held up his left front and trotted him off. It definitely made him more lame on the right front. They radiographed his left hock and stifle and both front feet. I don't know what else could cause him to be off on his left hind, he has been jumping for two years and never had an unsoundness there except for his accident in the crossties. I am going to start soaking his feet Sunday morning, and they will ultrasound both front limbs from the top of the suspensory all the way down to the soft tissues in the navicular area in his foot. They didn't block out his foot because the vet said he didn't think the lameness was bad enough, but it is obviously performance limiting.

Mary
Member:
Caymie

Posted on Monday, Apr 14, 2003 - 10:55 pm:

Hi all,
Just wanted to give you an update on Caymann.
We spent all day at the teaching hospital today.
They ultrasounded his right front from the top of the suspensory all the way down to the soft tissues in his foot. (It was actually a pretty interesting thing to see). Caymann has right front suspensory/collateral ligament of the navicular bone desmitis. The vet said it is a moderate injury. He is going to be shod with a straight bar shoe tomorrow to provide good heel support. I have to hand walk him for the next month, and hopefully he can be turned out the month after that. Probably no riding for at least two months.
So, I finally have the answer to my question.

Mary
Moderator:
DrO

Posted on Tuesday, Apr 15, 2003 - 7:10 am:

I hope his works out for you and Cayman, Mary.
DrO
Member:
Caymie

Posted on Tuesday, Apr 15, 2003 - 8:19 am:

Dr.O,
Thanks, me too. The vet believes that keeping him sound to pursue a career in dressage is a reasonable goal. I'm guessing that jumping is out of the picture. I guess we'll know more as his rehab progresses and we see how he does.

Mary
Member:
Caymie

Posted on Thursday, Apr 17, 2003 - 11:02 pm:

Dr O.,
Well the puzzle continues. I had Caymann shod on Tuesday by our new farrier. He is in a straight bar shoe. The farrier did a great job. Had my regular vet out this morning to watch Caymann go on asphalt. He is no longer lame on his right front. He is however, still very sore on his left hind. My vet (not teaching hospital vet) very strongly believes that this is really a left hock issue. He thinks that if the primary issue is the collateral ligament in his foot, (and the teaching hospital vet graded it as a "moderate" injury)then we should be seeing a "moderate" lameness, which we are not. He also questions how significant the ultrasound findings are as it is a relativey new procdedure, and since we never ultrasounded the foot before, we don't really even know how long that ligament has been damaged. I am starting to wonder if those wedge shoes , (which I was never happy about trying in the first place)made him sore in his front limbs. Which was my concern about trying them. He obviously has a left hind problem. My vet's idea is to block out that right front foot under saddle and see if he continues with his wierd hopping behavior. If he does it with his foot blocked out, then he thinks it is probably his left hind, and we inject it, give him a few days off and resume riding. If it doesn't solve the problem, then I guess we know it's his foot. I am just so hesitant to lock him up for two months for a lameness that as of this morning, even I am not seeing anymore. If his foot is causing this problem, I wouldn't have expected it to clear up quite this quickly. If anything, the vet said he thought he now looks a little off on his left front, which I am wondering is residual soreness left over from taking him out of the wedges and putting him in different shoes. Questions, comments? I could not be more confused. Thanks.
Mary
Moderator:
DrO

Posted on Friday, Apr 18, 2003 - 7:21 am:

You need to find one of the various folks examining your horse that you trust and stick with their recommendations. You will remain confused until then.
DrO
Member:
Caymie

Posted on Friday, Apr 18, 2003 - 10:51 am:

Dr O.,
I guess you are probably right. I think I will go ahead and let my regular vet try blocking out the foot and see what we find. Then I think I will stick with what my horse is telling me. One thing he has told me is that he is tired of being poked, prodded, sedated, etc. This is starting to seem a little ridiculous.
Mary
Member:
Caymie

Posted on Monday, Apr 21, 2003 - 10:28 pm:

Dr. O.,
Well, the plot thickens. I had my regular vet out today to look at Caymann. He blocked out the right front foot in question. That did nothing to alleviate his hopping behavior. He is still very sore in his left hock. So, he injected it. He will have a few days off and then I will ride him lightly to see if there has been any improvement.
Then we will go from there. The vet thought he might be a little off in his shoulder today. This just gets more interesting by the minute.

Mary
Member:
Suzeb

Posted on Tuesday, Apr 22, 2003 - 2:05 am:

Hi Mary,
I know it's Doc O's advice you are seeking, but, I would like to chuck in my 2 Cents worth. You have had Caymann reshod by a new farrier with different shoes, I am assuming on the recommendations of the surgeon who examined Caymann and whom made the diagnosis. The one you quote is right front suspensory/collateral ligament of the navicular bone. Sooo.. the new shoes gave Caymann some relief on the front end and just enough to show that there is actually something going on in the hind end, but I think it is too soon to be working Caymann just yet as he has suspensory injuries so now he he is hopping again on the front? Is the surgeon referring to collateral ligament injury that is coming from the hind end? The radiographs of the usual suspects (hocks, navicular bone and stifle) are checking out clean and ultrasound of the tendons and ligaments that may be involved are checking out what? You said that the surgeon ultrasounded Caymann's foot. Was he/she trying to localize impar ligament pathology? You are right Mary, the plot is thick and I do hope you get this sorted out. May I suggest that you work with the surgeon and the farrier that he/she recommended and perhaps have your local vet contact these people and get the pieces of this puzzle on the table and put in some sort of order. This "Yak Attack" wouldn't be complete without suggesting that you run searches on this site using the words in the diagnosis that the surgeon gave you. Incidently, Dr.O, I ran one on collateral ligament and although it said there were 36 possibilities I couldn't get anything to show. Hope this helps Mary. Susan and Laser B. :-)
Moderator:
DrO

Posted on Tuesday, Apr 22, 2003 - 6:28 am:

I have to admit Mary that this confusion between is it a front foot or a rear hock strikes me as well...usually there is no problem distinguishing a front limb lameness from a rear limb lameness. Then the concentration on 2 pieces of anatomy when the problem could be anywhere.... If it is thought to be in the hock, intraarticular anesthesia would answer this question quickly.

Susan I too get 36 entries but have no problem reaching them. I have not had any other reports of problems with the search engine in the past 8 months. Try again and if it persists please email us with details of what happens.
DrO
Member:
Caymie

Posted on Tuesday, Apr 22, 2003 - 9:27 am:

Hi Dr. O and Susan,
I appreciate both your input:-) I think we have so many things going on here that it is difficult to sort it out. Last week at the teaching hospital, they ultrasounded Caymann's right front leg, from the top of the suspensory down to the soft tissues in his foot. He was diagnosed with desmitis of the collateral/suspensory ligament of the navicular bone in his right front foot. He was on that day, off on his right front foot. (Grade 1)

Several days later he was no longer off on his right front foot, but a little off on his left front. When the vet was out yesterday, he said he looked a little off on his shoulder, but not off on either front limb. (Next it will be his head, I'm sure).

Yesterday the vet blocked out the right front foot. No improvement in the way Caymann is going.
If his foot were causing this entire problem, I would have expected that to help. Still very off/sore on his left hock. Injected left hock.
I will give him some time to rest and try him out again under saddle to see if there has been any improvement.

Here is my theory:

Caymann started exhibiting trouble under saddle about three months ago. It was very subtle, and I only noticed it because I know him so well. I am wondering if he was starting to have some hock soreness then. Then he injured his suspensory in his right front. Then we put him in those wedge shoes, (Bad idea) which totally changed his way of going. I am guessing that those shoes, because of the way he was travelling and wearing the toe, made him very sore in his front end. Or maybe his right front was off due to the real problem being his left hock. Hock problem continues to get worse throughout all of this. Then we pull the wedge shoes, and have him shod in a straight bar shoe.
After looking VERY sore for a few days, he starts to get better in new shoes. Hock is still sore.

It is hard for me to determine the significance of that ultrasound at this point. Given the problems we have had with shoeing the past couple of years, I am not surprised there has been some damage to the collateral ligament in his right front foot. Since I have no way of knowing how long it has looked like that, and when the foot is blocked out he is still lame, I question if that is the primary issue here.

Susan, to answer your question, my ambulatory vet also works for the teaching hospital, so he is able to discuss this with them. This is not the first time we have had some "differences of opinion" with what the teaching hospital has said.

This horse will do no further work until we get to the bottom of this. I just wanted to eliminate the hock soreness from the equation. Then we will proceed with addressing any further issues as needed. If he has returned to normal once the hock is healed up, then I guess we have our answer. My vet said he thought there was some mild arthritis on his hock rads.

Sorry this is so long and confusing.This is our strangest episode yet, (and we've had a few).
I will run the search on this subject as you suggested Susan. Do you guys have any other ideas as to what could be going on here?

Thanks,
Mary
Member:
Cara2

Posted on Thursday, Apr 24, 2003 - 7:40 am:

Hi Mary,

You are certainly on a magical mystery tour with your horse. I had a sudden thought about his strange gait. When I stupidly DrOpped a freshly boiled kettle over my legs and foot I adopted a strange way of walking to prevent pressure from my shoe on the scald on the top of my instep. The healing process took 2 months and for weeks afterwards I still walked that way. I just couldn't get out of the habit. I wonder if Cayman is doing something similar?
Member:
Caymie

Posted on Monday, Apr 28, 2003 - 8:11 am:

Hi all,
The mystery horse tour continues. I got a copy of Caymann's radiology report. The radiologists conclusions were the following:
(they took rads of his left hock, stifle and a navicular/P3, right fore)

"These findings indicate continued presence of a subchondral bone defect in the left stifle. The change in size of the bone fragment may indicate growth of the osteochonDrOma. The old osteochonDrOsis lesion of the left stifle remains unchanged. The changes of the lateral collateral cartilage of the right forelimb most likely indicates fracture of the lateral collateral cartilage of P3, this should be clinically correlated."

We injected his left hock last week. I am going to get on him and see if he is any better today. I am thinking about taking him down to a very well respected private equine clinic this week for a third and independent opinion.

I do think that part of Caymann's soreness was the wedge shoes and now he is getting used to being in a straight bar shoe.

Any further ideas are welcomed!
Mary
Moderator:
DrO

Posted on Tuesday, Apr 29, 2003 - 5:54 am:

He too makes the same suggestion when he says these should be clinically correlated: block it out before you blame it as the area of pain.
DrO
Member:
Caymie

Posted on Wednesday, Apr 30, 2003 - 10:50 pm:

Dr. O.,
I think we are starting to see some light at the end of the tunnel. I had my regular vet, (who I trust the most) block out Caymann's front foot.
No improvement in his gait. He was still off on his left hocks so he injected his left hock last week. I rode him on Monday briefly and he was much better, although still off somewhere
up front. My vet agreed last week that in addition to being off on his left hind, that something is not quite right up front. However, he does not believe for a minute that this has anything to do with his alleged foot problem. So, we are slowly eliminating the problems one at a time, and will now work on figuring out what is still bothering him. It is hard to figure out where to begin when the horse is sore all over. He will be out next week to continue working on the mystery.
I am very encouraged though, I feel like we are making some actual progress. (that makes sense).

Mary
Mary
Moderator:
DrO

Posted on Thursday, May 1, 2003 - 4:52 am:

Very good: start working on the the leg that is most obviously lame. Start at the bottom and work your way up. Once the worse leg is sound from blocks go to the next worse leg. Quickly you will know exactly where your horse is and is not lame.
DrO
Member:
Caymie

Posted on Thursday, May 1, 2003 - 8:13 am:

Dr. O,
Can a subchondral bone cyst/OCD lesion in a stifle cause a horse to act like he is hopping up front?
I just wondered. The vet thought he felt some effusion in Caymann's left stifle as well. I guess that is where we will look next, and if that doesn't solve the problem, start looking up front.
Caymann had arthroscopic surgery when he was almost five for OCD in both hocks and stifles.
Thanks for your input.

Mary
Member:
Caymie

Posted on Monday, May 5, 2003 - 10:02 am:

Dr. O.,
Some days I think I must be making this up. I rode Caymann this past Thursday to see if the hock injection had improved his hopping/shuffling. It did not. The day after I rode him LIGHTLY, he was dead lame in his right front. After a couple of days of rest, he looks better. Our two options are his feet or his shoulder. It sometimes looks like his shoulder, but I think it's his feet. We are going to start blocking out his right front, from the PDN all the way up to the shoulder if necessary until he is sound. Do you advocate doing both a PDN and a coffin joint block?

Mary
Moderator:
DrO

Posted on Tuesday, May 6, 2003 - 11:12 am:

No the foot and the shoulder are not your only two options: there is the whole rest of the leg that has to be ruled out. We cover the order of blocks and their interpretation in Equine Diseases » Lameness » Foot and Sole Problems » Overview of Diagnosis and Diseases of the Foot.
DrO
Member:
Caymie

Posted on Tuesday, May 6, 2003 - 3:49 pm:

Dr. O,
You're right, I realized how funny that statement sounded. We are going to start at the foot and work our way up to the shoulder until he is sound.
(Hopefully, he will be sound at some point in this process). The vet had me ride him today to try and make him sore again and he will be out to begin blocking tomorrow. I hope we can come up with an answer that makes sense. My vet blocked out his right front foot with the PDN and abaxial?
(I think that's what it's called)block, and no improvement. Our quest for an answer continues!
He flexed his hock and said he is still a little off there too. I think if he doesn't block out up front, we may do some blocking in his left hind.

Mary
Moderator:
DrO

Posted on Tuesday, May 6, 2003 - 6:31 pm:

No Mary, I think messing around back and forth is a mistake: stay focused on the most lame leg until you figure that one out! (I don't use exclamation marks often.)
DrO
Member:
Caymie

Posted on Wednesday, May 7, 2003 - 8:48 am:

Dr. O,
The exclamation mark is duly noted. I just don't think Caymann is off enough behind for that to be the cause of his front end problem. He was head bobbing lame up front starting last Friday. The weird thing is, he seems to get better with rest, and then lame again when you work him. Hopefully he will look lame enough today for the vet to see what's going on. I am certain that this is a front limb problem. I'll let you know what we find today.

Thanks,
Mary
Member:
Caymie

Posted on Wednesday, May 7, 2003 - 10:54 pm:

Dr. O,
Well, the three/four month mystery has been solved! My vet came out today and first blocked Caymann's right front foot again just to be sure.
No change. Then he blocked out his left hind stifle, as this was the only lameness he could see on the lounge. He was about 90% better. After we took care of that problem the vet thought he still saw a little something up front, but this was only under saddle. He blocked out his suspensory. Suddenly I have my normal horse back. He looks and feels sound and now the hopping is completely eliminated. Apparently he was worse in back and because of the strange way it presented, I thought it was up front. He was not off on the right front this morning like he was on Friday, so the vet started where he could see the most lameness, which was behind. He thinks the suspensory is mildly sore on the right front because of the way he has sort of been rocking off of it due to his hind end problem. And we know his hock was sore too, which he injected last week. So, he will be out to inject his stifle on Monday, he will have three days off and then hopefully we can resume riding. Have you ever heard of a case where a stifle problem caused the horse to shuffle off/hop
up front? The vet said it looked like he would start to put his left hind down, and then sort of jab it into the ground, and step off it again because it hurt. This has been a weird episode even for us, and believe me, Caymann has had a lot of them. Thanks so much for your input.

Mary
Moderator:
DrO

Posted on Thursday, May 8, 2003 - 6:10 am:

I am not sure what to make of your description Mary. Clear signs of diagnosing front and hind limb lameness are described and illustrated in the article on Diagnosing Lameness. Though hind limb lameness can be a bit variable, front limb lameness is almost always straightforward using these rules.
DrO
Member:
Caymie

Posted on Thursday, May 8, 2003 - 8:57 am:

Dr. O.,
The only lameness the vet has been able to see throughout this entire episode had been on his left hind. He was lame on his right front last Friday on the lounge with no saddle or rider. However, when the vet was out yesterday, he was no longer lame on his right front, other than this strange shuffling/hopping thing he does under saddle. Maybe he strained something while turned out, or maybe his hind end was really bothering him that day so he looked worse up front. The vet has always felt that throughout this whole episode, the primary lameness has been coming from behind. I do know that once he blocked out his stifle and then his suspensory, the horse was sound again. I guess I will know more once they inject his stifle and we see how he does.

Mary
Member:
Caymie

Posted on Saturday, May 17, 2003 - 1:19 am:

Dr. O.,
Well, I'm not sure what to make of my description anymore either. They injected Caymann's stifle on Monday. I rode him today for the first time since then. He is not much better than he was before.
My questions are as follows:

I still(and have belived for four months now) that this problem is a right front issue. This is a very strange lameness as it mostly manifests itself under saddle. However, as I told you before, two weeks ago, he turned up dead lame in his right front, on the lounge line, no saddle, no rider.

1)Could this be indicative of an ongoing suspensory problem. His last suspensory strain was in January. When I started riding him after that, (after four weeks of rest), he started this hopping/shuffling thing up front that has gotten progressively worse over the past few months. Can a suspensory injury look really bad one day, and then look much improved a few days later with some rest, (but can there still be a problem even though the horse isn't overtly lame?)

Would you recommend another ultrasound of the suspensory? It has always bothered me that he was never ultrasounded before he went back to work.

Could this also be a foot problem? I am starting to wonder if the teaching hospital wasn't right about his foot. But why isn't he sound when they block the foot if the foot is the problem? Would you recoommend a coffin joint block? This has never been done, just a PDN and an abaxial.

Does this sound like a stifle problem to you?
I would have expected the injection to help a lot more if his stifle were the problem. He has had these bone chips or whatever they are in his stifle ever since his OCD surgery three years ago and has never had a stifle problem, even with us doing the jumping for the past two years.

The vet's idea that this is all being caused by his stifle no longer makes any sense to me. The problem is, not much makes sense at this point.
I am thinking of having them come out Monday and block his supensory again and I will ride him after the block and see how he does. I REALLY feel that this is a front limb issue.

Thanks,
Mary
Moderator:
DrO

Posted on Saturday, May 17, 2003 - 8:31 am:

You cannot block the suspensory without blocking out the rest of the lower leg: start at the bottom and work up if that has not been done.
DrO
Member:
Caymie

Posted on Saturday, May 17, 2003 - 11:33 am:

Dr. O.,
OK-I think I will have the vet start at the foot again and work his way up. This has been done before, but this whole thing is just starting to make no sense to me. The vet said he blocked the suspensory last week, after he blocked the stifle, but from what you're telling me that suspensory block included the rest of the lower leg? I assume it does not include the foot?

Mary
Member:
Caymie

Posted on Saturday, May 17, 2003 - 7:50 pm:

Dr. O.
One other thing I thought I might mention. Last week Caymann had a very weird episode around 9:00 p.m. He wouldn't eat a thing, (VERY odd for Caymann)even his grain or his carrots. And he acted like he didn't want to move at all. Looked very stiff. And when I tried to give him a tiny bit of hay, he had trouble chewing it, almost looked like he was chewing in slow motion. So I gave him some Bute and that seemed to help after about an hour. Maybe he was just briefly thinking about colicing, (he is not a colicky horse) but it was really odd. I guess in the back of my mind I am also wondering if some sort of neurological problem could be going on, with the OCD/arhtritis in his neck, and all this other wierd stuff. I guess we'll just start with the right front on Monday.

Mary
Member:
Suzeb

Posted on Saturday, May 17, 2003 - 10:16 pm:

Hello Mary,

I feel as if I am reading about a near carbon copy of my horse and all of the difficulties everyone has been going through. Laser too had an episode of not wanting to eat and move last summer and fearing laminitis or founder I called the Vet out on emergency. The guy was better after a shot of Ketoprofin (Nsaid), although what the heck brought that on. I have been hovering over your posts to see what gives and the question that comes to my mind is: When did Caymann start having arthritis in his neck? I don't think you have brought this up before, with the exception that Caymann has a sensitive back. I was thinking about posting the possibility of something going on in the back if the foot/leg diagnostics were coming up inconclusive or at least nobody can figure out what the %*&#@ is going on. There are a few things I can suggest you do Mary is:

1. Keep a journal and make note of all the things that you do with Caymann as per vet instructions and if you have access to a weather channel or website make note of your local conditions also.

2. Shoeing changes take time to adjust to, particularly when they are altering the mechanical forces on the tendons/ligaments and possibly bone structure of your horses legs. Take into account the footing underneath this guy and the type of work he is asked to do.

3. Overhaul his diet. I noticed that you are giving Caymann grain. If the guy is having on again off again lameness whether it is from the front or the back or both and he needs some down time or stall rest you might want to give up this diet substance.

4. If all you can do at the moment is take him for 10 or 15 minute walkies, tell him all the things you are doing to him and why you are doing them he will understand. I can't offer the scientific explanation of this Dr.O but they do listen.

I hope this helps you Mary and I apologise for the graphics, but you have been in for a tough time and I hope you get it sorted out.

Keep us posted, Susan B.
Moderator:
DrO

Posted on Sunday, May 18, 2003 - 8:36 am:

There is no such thing as a specific suspensory block really. You can infuse anesthetic around the suspensory in a "regional block" but the nerves that supply the distal leg run along each side of the suspensory, they are blocked too when the suspensory is blocked. That is one of the reasons, that localization has to proceed in an orderly manner from the foot up.
DrO
Member:
Caymie

Posted on Sunday, May 18, 2003 - 11:33 am:

Susan,
Good to hear from you again. I especially enjoyed your advice to explain to Caymann why I am doing what I am doing. I know he listens too. We just won't tell Dr. O.

Last September I took Caymann up to the teaching hospital because he was having trouble bending his neck. One of the lameness surgeons tried treating it chiropractically a couple times without much lasting improvement. So, he wanted to radiograph his neck. They found arthritis/OCD (you pick the name, he was only seven years old) in a couple of his vertebrae. They used a guided ultrasound to inject the facets in his neck. That's why I sometimes wonder if there is something going on with his neck.

But I'm not sure, (of anything really at this point) if I really think it's his neck. He is eight-I thought that was too old to have difficulty from cervical malformation or whatever they call it. He also had OCD surgery in both hocks and stifles when he was four.

I still think the problem is in his right front, which I have been saying all along. The weird thing about all this is the lameness is so intermittent. He is always off on his right front under saddle, that's when he does that hop/shuffle off of his right front. And it's pretty bad, we can't even go around at the trot normally. Now yesterday he was even doing it on the lounge. And two weeks ago he turned up dead lame on his right front on the lounge with no saddle or rider. Then after a few days rest, he looked better. My theories are that his suspensory is bothering him again, or it is his foot( we had his feet ultrasounded a month ago)or a little bit of both. I just don't understand why we can't get this figured out and I sort of feel caught between what the surgeon is telling me and what my vet is telling me. I think they are in some sort of weird situation where each is trying to prove the other wrong.

I am still going to have the vet out tomorrow to block out that right front leg. He has been saying I can turn Caymann out. What we are doing is obviously not working. I am starting to think that maybe I need to try what the teaching hospital vet told me and stall rest him for a month, and then a month of gradual turnout and then start him up if he is sound. The diagnosis of his foot was desmitis of the collateral/suspensory ligament of the navicular bone. We'll see what happens when the vet blocks out his foot tomorrow.

Sorry this is so long, I'm just frustrated. I am definitely going to cut back Caymann's grain and give him his supplements in his oats. I won't tell him you suggested that. And I know the shoeing change will take time, but he started this hopping thing back in December, and it has gotten progressively worse since then.

I am also going to buy him some toys to play with in his stall.

Thanks for all your input,
Mary
Member:
Caymie

Posted on Sunday, May 18, 2003 - 11:34 am:

Dr. O.,
Thanks for clearing up the suspensory block question. I will make sure the vet starts with the foot.

Mary
Member:
Caymie

Posted on Monday, May 19, 2003 - 2:13 pm:

By the way Susan,
No need to apologize for the graphics. Multiply yours by about oh I don't know, a thousand maybe, and you will have the same amount I have been using!

Mary
Member:
Caymie

Posted on Tuesday, May 20, 2003 - 12:53 am:

Dr. O., and Susan,
Well, it appears we have our answer. The vet came out today. Since a few days ago Caymann has now been consistently off on the lounge as well. He blocked out his foot and he was better, (less hopping, willing to turn to the right)but it didn't completely solve the problem. Then he blocked out his suspensory and he was completely sound. So, I insisted that he ultrasound his suspensory. He has a lesion in the proximal area. I also had him radiograph his cannon bone and fetlock. We'll have those results tomorrow. My feeling at this point is that both the collateral ligament in his foot and his suspensory ligament are bothering him. Is that possible Dr. O?
Also, the vet mentioned injection some HA and steriod into the suspensory. What do you think of that idea? He is now on stall rest and I plan to consult your artile on Suspensory injuries for his rehab. I don't think it ever completely healed from his January injury. And I will INSIST on another ultrasound to monitor healing and before he is put back to work. I figure whether it's only the suspensory or the suspensory and the collateral ligament the treatment is the same.
Rest (maybe for two months at least), handwalking, and then gradual turnout. Which he will be sedated for! So anyway, thanks for all your input and ideas. This is going to be a challenge for him and for me, but he is young, and if I have any hope of him healing up for real, we have to do this.
Anyway Dr. O, if you could let me know what you think of injecting that suspensory and if you think my theory of both things bothering him is possible I would appreciate it. Is it possible for
partial improvement with a block if there are two concurrent problems?

Thanks,
Mary
Member:
Caymie

Posted on Tuesday, May 20, 2003 - 9:30 am:

Dr. O.,
Two last questions. When they ultrasounded Caymann's feet at the teaching hospital a month ago, (and I know this is a relatively new procedure), they indicated that the naviclular bone in his right foot looked a little rough.
The rads didn't show anything. Do you think there would be any benefit to putting Caymann on Isoxuprine while he is resting? Also, is there ever any correlation between foot pain and repeated suspensory injuries?

Thanks,
Mary
Member:
Suzeb

Posted on Tuesday, May 20, 2003 - 10:08 am:

Hello Mary,
I am so glad to hear that you are finally getting to the bottom of Caymann's problems. Poor Guy! and Poor You! I guess it does help getting a little graphic when nice and polite is not yielding any results. Sounds like your mobile vet and the surgeon have regular p*&%ssing contests. I still feel that a lot of these problems have come from Caymann's low or underrun heels. Work closely with one of these vets and the farrier together for proper support shoes and take note of any changes for the better or worse every time he is reshod or reset. The massage therapy will also be good for Caymann while he is on stall rest. Do read up on rehabing suspensory injuries. You have had a lot on your plate, but elephants can be eaten, one bite at a time. Good luck with Caymann and let us know how he is doing. Cheers, Susan and Laser B.
Member:
Caymie

Posted on Tuesday, May 20, 2003 - 3:20 pm:

Thanks Susan, I really appreciate all your good advice and help. I think this has been going on for a long time and if I have any hope of getting Caymann really healed up, we'd better bite the bullet and give him the time he needs to rest.
I won't even go into all the p*&%ssing contests I have entered these past few months. Too numerous to count. ANYWAY, I have a great farrier now who I have a lot of confidence in. He currently has Caymann in a (hand forged, italian shoe quality etc, just like your Laser) straight bar shoe with
some Equithane on him as well. His feet, (for the first time in three years)look great. I totally agree that his being shod incorrectly all this time has been a major contributor to his struggles. That and the fact that he is just a massively built horse. He is getting a massage once a week right now from my friend who is an equine massage therapist. I will be doing all the reading I can get my hands on. And I will report to Caymann what I learn on our walkies. Thanks for your encouragement. Hope Laser is doing well. We'll keep you posted.

Mary
Moderator:
DrO

Posted on Tuesday, May 20, 2003 - 7:56 pm:

Until the lameness is localized and then diagnosed I am not sure these questions have much meaning concerning your specific case. We do have an article on isoxsuprine at » Equine Medications and Nutriceuticals » Miscellaneous Drugs » Isoxsuprine.
DrO
Member:
Caymie

Posted on Tuesday, May 20, 2003 - 8:17 pm:

Dr. O.,
I will read the article on Isoxuprine. I guess I am confused as to why you don't think the lameness is localized. He definitely has a lesion on his suspensory ligament. When the vet blocked out his foot, he was better but not totally sound. Then when he blocked out his suspensory he was sound to the right. He was still having trouble to the left, so we waited a little longer for the block to take effect and then he was sound. Isn't it possible that both the collateral ligament in his foot and his suspensory ligament could be bothering him? If it is just his foot, why doesn't he go sound when they block it. The only thing in his foot that hasn't been blocked is the coffin joint, but the vet told me that the PDN block, blocks the entire foot.

Mary
Member:
Caymie

Posted on Tuesday, May 20, 2003 - 9:03 pm:

Dr. O.,
I am wondering if you didn't see my previous post on Tuesday where I reported the findings from my vet visit?

Mary
Member:
Caymie

Posted on Wednesday, May 21, 2003 - 9:40 am:

Has anyone else ever heard of injecting some HA and/or steroid around the suspensory ligament to reduce inflammation? If so, what do you think about this idea?

Thanks,
Mary
Moderator:
DrO

Posted on Wednesday, May 21, 2003 - 10:12 pm:

Mary from your posts I cannot tell if it is localized on not: there is a lot of tissue between the suspensory and the foot when the block jumps from one to the other. I only know what you tell me and I do not see clear evidence you have a coffin joint colateral ligament / suspensory desmitis.

I can try to educate you on how lamenesses are localized and diagnosed but you must decide when things are copacetic.
DrO
Member:
Caymie

Posted on Wednesday, May 21, 2003 - 11:16 pm:

Dr. O.,
Well, I guess in my mind we now have two problems here. I have an ultrasound exam of his foot that shows moderate desmitis of the collateral ligament of the navicular bone. As of Monday, I also have an ultrasound exam that shows a lesion on the high portion of his suspensory ligament. Back in April when the ultrasounded his foot, they did his entire leg from the top of the suspensory down. The only thing they found then was the desmitis of his collateral ligament, which the radiologist said was remarkable. On Monday when the vet blocked out his foot, he improved, and when he blocked out the suspensory he went completely sound. Rads of his cannon bone and fetlock do not show anything. While I do admit that this has been sort of a haphazard way of going about it, (due to the battle between two vets) I think we now have two things going on here. Either way, I am going to stall rest him for three months with handwalking, have his foot and suspensory re-ultrasounded and go from there. I would rather err on the side of more time off than less since he has had so much trouble with this.

Mary
Member:
Caymie

Posted on Saturday, May 24, 2003 - 12:11 pm:

Dr. O., and company,
I have made an appointment to take Caymann down to Littleton Large Animal Clinic on June 5th. I have decided that I want an independent party opinion.
I feel like I am being manipulated by both sides, between the teaching hospital and my ambulatory vet. Which is ironic since they both work for the same institution. The way all of these lameness exams have been conducted does not make any sense to me. In the meantime, Caymann is going to continue to rest with handwalking. I'll keep you posted.

Mary
Member:
Caymie

Posted on Saturday, May 24, 2003 - 7:32 pm:

Dr.O.
The other interesting thing that happened on Monday was that after the vet did the PDN block and I felt Caymann improved, he then went right to a suspensory block. Well, the horse was sound to the right, but when I circled him to the left, he was hopping as badly as he used to to the right.
I asked the vet to block the left foot, but he didn't want to do it. He said it was because of his right suspensory soreness that he was now lame to the left because that leg was on the outside. (This is allegedly a high suspensory injury). My question is this, is it possible for the block to be effective enough to the right, but not effective at all to the left because that leg is now on the outside? Oh my, I am starting to think I am crazy. Hence the third opinion.

Mary
Moderator:
DrO

Posted on Sunday, May 25, 2003 - 8:57 am:

The question here Mary is which leg was lame following the block: there are some lamenesses worse when on the outside.
DrO
Member:
Caymie

Posted on Sunday, May 25, 2003 - 9:54 am:

Dr.O.,
Well, my vet said it was still the right front that was lame. A few weeks ago he said the left front looked off. The problem is, I was riding the horse at the time so I couldn't see it for myself.
My questions are these:
If the leg was blocked out, why should he be lame in either direction?

What lamenesses are worse on the outside? Are there others that can be worse on the outside besides a suspensory problem?

Mary
Moderator:
DrO

Posted on Sunday, May 25, 2003 - 11:25 pm:

Mary I cannot say specifically why your horse has done what you tell me he does. You wanted to know why the lameness may have switched from being worse on the inside to worse on the outside while the vet is telling you that it was the same leg.

The only explanation I can think of is that the horse is lame in two different places in the same leg one of which is worse when the leg is on the outside. It is irregular as to which lameneses look worse on the outside but it happens about 10% of the time.
DrO
Member:
Mwebster

Posted on Monday, May 26, 2003 - 8:46 am:

DrO, which lamenesses look worse on the outside? Would coffin DJD do this?
Thanks,
Melissa
Member:
Caymie

Posted on Monday, May 26, 2003 - 9:34 am:

Dr. O.,
If it's irregular, Caymann will do it. He always likes to be the exception to the rule. I too think it is very possible that Caymann is lame in two places in that right front leg. Actually, I am almost convinced of it. Unfortunately, the way that all of these lameness exams have been conducted makes very little sense to me. It seems like they have all been done in a way to support everyone's theories. Therefore, I am taking Caymann down to Littleton Large Animal Clinic on June 5th, for a third, INDEPENDENT opinion. In the meantime, he is resting with handwalking only, which I figure will not hurt him.

One last question about the lameness worsening on the outside-can any type of foot pain cause that?
Is there a difference between medial and lateral foot pain?

I'll let you know what we find out on the fifth.

Mary
Moderator:
DrO

Posted on Monday, May 26, 2003 - 6:19 pm:

I think that pain in the medial aspect of the foot may cause increased lameness when the foot is on the outside of the circle particularly if the horse travels unbalanced, say like a green horse. But as stated above, this is not always true.
DrO
Member:
Caymie

Posted on Monday, May 26, 2003 - 11:22 pm:

Dr. O.,
Well, I don't know what to think at this point other than we seem to be regressing instead of progressing. How long have ultrasounds been done to examine soft tissue in the foot? Have they been done long enough to be a reliable diagnostic tool?

Mary
Moderator:
DrO

Posted on Tuesday, May 27, 2003 - 5:33 am:

Only where there is excellent equipment, not the usual field units, in experienced hands.
DrO
Member:
Caymie

Posted on Tuesday, May 27, 2003 - 6:09 pm:

Dr. O.,
Well, this was done at Colorado State University's
teaching hospital using their in house unit with the special probe you need to do it or whatever.
It was done by a person who is experienced in ultrasounding the foot, I guess she studied a little bit with the person who pioneered this procedure. Someone from France. And she's done it at a private clinic out in California as part of her residency.

Mary
Member:
Caymie

Posted on Friday, Jun 6, 2003 - 1:31 pm:

Dr. O.,
Well, I had Caymann examined again yesterday. He did not see any lameness up front. However, he is still moderately lame on his left hind stifle. So, apparently whatever is going on in there was not alleviated by the injection. So, they are going to ultrasound the stifle the week after next, and then based on what we do or don't see, scoping it arthroscopically will be the next step. So, at this point, it looks like we have a stifle problem and a lesion on his right front suspensory that is probably in the process of healing. I am hopeful that we have caught this in time because he is not severely lame behind, but we won't know until further diagnostic work is done. I know that the prognosis for stifle problems can be somewhat guarded, but we'll just have to wait and see.

Mary
Moderator:
DrO

Posted on Friday, Jun 6, 2003 - 4:00 pm:

Let us know what they find Mary.
DrO
Member:
Caymie

Posted on Friday, Jun 6, 2003 - 7:08 pm:

Dr. O,
I will-the ultrasound is June 18th, and then based on what may or may not be found on that, he will be scoped arthroscopically in early July. I am still hopeful that whatever it is can be helped because this hasn't been going on that long and he's not that lame, but we'll just have to wait and see.

Mary
Member:
Caymie

Posted on Wednesday, Jun 18, 2003 - 5:19 pm:

Hi Dr.O.,
They ultrasounded Caymann's stifle yesterday.
It looks like he has a meniscal problem. They are going to arthroscopically scope it this Friday.
The vet said he has been able to return about a third of horses to athletic function with this type of problem. Not great odds, but better than doing nothing. He did say that many of the horses he has successfully treated have been lamer than Caymann is so that is the one bright spot. So, I guess I will have my answer on Friday once they get in there and see exactly what is going on.

Mary
Moderator:
DrO

Posted on Wednesday, Jun 18, 2003 - 9:03 pm:

I am sorry to hear this but there is some contentment in knowing that they are getting down to the problems.I will keep my fingers crossed.
DrO
Member:
Dres

Posted on Wednesday, Jun 18, 2003 - 9:06 pm:

Mary, Dr.O , would one of you explain a meniscal problem.

thank you... Ann
Member:
Caymie

Posted on Wednesday, Jun 18, 2003 - 11:49 pm:

Hi Dr. O.,
Thanks for the good thoughts. I will continue to hold out hope until I have my answer on Friday. Caymann is a very special horse who will remain with me for the rest of his life regardless of the outcome. And you are right, after four years of non-stop health problems, there will be some relief, I guess you could say in finally having an answer. He has struggled since the day I purchased him, but I will know that I have given him every opportunity available to equines today.
I will let you know what they find on Friday. And I will let you explain the ins and outs of what a meniscal problem is to Ann.

Mary
Moderator:
DrO

Posted on Thursday, Jun 19, 2003 - 6:52 am:

Hello Ann,
Check out the article on stifle lameness. You will find diagrams showing and describing the meniscus. Then under diagnosis you will find a description of the most common type of meniscal tear, treatment, and prognosis. I have edited some of this article to bring together information that was scattered through it and the scientific reports to make it easier to find.
DrO
Member:
Dres

Posted on Thursday, Jun 19, 2003 - 10:11 am:

Dr. O.. thanks., lots of great info... more for me to worry about..

Mary, will think of you and Caymann on friday... boy do i understand the wait and see worry..!!

may i ask.. has Caymann been 'off' since you purchased him..? how long ago..?

fingers crossed Ann
Member:
Caymie

Posted on Thursday, Jun 19, 2003 - 11:05 am:

Ann,
I purchased Caymann four years ago when he had just turned four. He had OCD in his left hock at the time of purchase, however the vet that vetted him, missed it on the x-ray. (I later had the x-ray sent to CSU prior to his surgery, and they saw it immediately). And yes, he has been slightly off since I purchased him. Several months after I purchased him he showed up with OCD in his right hock as well and both stifles. He had arthroscopic surgery on all four joints. Several weeks later he almost died from equine influenza. Then we spent the next two years with several suspensory strains, and some shoeing problems that didn't help. In between all of this he strained his left hock once when he attempted to flip himself over in the cross ties, and strained his left hock and stifle again when he got cast. (We are wondering if that didn't set this current problem in motion). He also has some changes in the ligaments in his right foot, but that does not appear to be clinically significant. He has also had the facets in his neck injected due to arthritis there. And he's only eight.
It seems like he has spent more time resting than working since I bought him!

It helps to know there are others who understand the "wait and see" worry. He will be in the hands of Dr. Trotter at CSU tomorrow, there is nobody better for joint issues. Despite all the drama that went along with trying to figure this out, he has recevied excellect care from both my field vet and Dr. Trotter, who both work for CSU.

That was probably more information than you wanted:-) Is your horse having a problem with his stifle?

There are alot of people hoping that Caymann will overcome yet another obstacle. You guys are great-thanks for the encouragement. I'll let you all know what they find tomorrow.

Mary
Member:
Dres

Posted on Thursday, Jun 19, 2003 - 12:01 pm:

WOW..{/b


well i hve to say you have been doing the wait and see long enough... i truly hope this gives you the answers needed....

i have a young 4 year old that i raised.. he has been one of those horses that if it can happen to... it will!

no, stifle problems .. knock on wood... but many .,and 'odd' ones that you don't see often...(mountain lion attack) to many to list on this link... i do understand!!!

keep us posted...

Ann
Member:
Sross

Posted on Thursday, Jun 19, 2003 - 12:55 pm:

Mountain lion attack?!
Member:
Caymie

Posted on Thursday, Jun 19, 2003 - 4:20 pm:

Ann,
Well, I guess there have been some things we haven't done yet, most notably a mountain lion attack. Oh my. You'll have to tell us more. What kind of horse do you have? Are you currently riding him?

I'll tell Caymann about the mountain lion-maybe he will feel fortunate:-)

Mary
Member:
Dres

Posted on Thursday, Jun 19, 2003 - 7:04 pm:

Picasso is my claim to fame.. or VET BILL... he is a spotted warmblood with such potential , if i can only keep him alive... 3 days after he was born he was stuck between two fighting broodmares and a rock, got a cut from his hip all the way down his leg thru his cornet band... left a nice scar on that hoof... ( egg bar shoe now on that one hoof)
at 7 weeks old his mother and he were attacked by a mountain lion... it happened the night the rest of the herd had been taken away , they were alone... if it had not been for his mother making such a ruckus , we might not of had a live colt the next morning... as he had been thrown over the fence by the force of the attack and left to die.. or cat food... mom raced from fence to house SCREAMING.. midnight/full moon... intensive care for 2 weeks and then months of doctoring.... his chest was gutted out.. pectoral muscle was left hanging out... nasty wound but healed sooo nicely....
as a weanling he decided to go out a closed gate.. broke his nose.... vets were worried about bone infection not a lump on his beautiful head... no infection.. ( for a change) but a lump is still there... !
i gelded him .. that got infected... ( they never get infected..) had an extreme case of pigeon fever & got pneumonia along with it...
he is photo sensitive, so i keep him in by day out by night.. or he gets these wart like sores on his white parts.. mostly socks... at 3 he had eye surgery .. there was a lymph node that went a muck and started to wrap around the optic nerve... if we had not gotten to when we did , the surgeon would have had to crack the eye socket.. ( lucky?) i saw this for lack of better words , pink worm type growth in the corner of his eye... thank goodness it was growing in both directions..!!!
and hopefully last ... just got him back from the trainers and he fell out of my trailer... he broke his extensor process of the coffin bone... ( thought it was a wing dr. o).......... so you see... we all have our stories....

in my profile is a picture of 'VET BILL' as a yealing ... i hope that i will be able to show him off in the dressage ring sometime soon and show ALL what a wonderful moving horse this spotted appaloosa is.... if i can keep him alive..!!!

** sorry for such a long story .. in this section...pix is taken with the wound 3 weeks old

Anntaken 3/4 weeks after
Member:
Caymie

Posted on Thursday, Jun 19, 2003 - 7:52 pm:

Ann,
Well, if your horse can make it through all that maybe Caymann can overcome this latest obstacle.
(It is starting to sound kind of minor compared to what your guy went through). As a similarly devoted (or crazy, can't decide which)owner, I admire your dedication and patience. What a saga!
He must have a very strong will to live. Where do you live? Maybe my vet and your vet can fund their retirement accounts together with the proceeds from our vet bills.

(Just kidding Dr.O.,most great field vets I know ought to make three times what they do) I must also comment on your continued sense of humor, I know that's gotten me through some difficult times too. So how is he doing now? When will you be able to ride him again? And he's a very handsome boy, by the way.

Mary
Member:
Caymie

Posted on Friday, Jun 20, 2003 - 11:47 pm:

Hi all,
Well, we had a long day at the vet hospital today. They had two emergency colics so they didn't start with Caymann until four in the afternoon. The surgeon found absolutely nothing wrong with his stifle other than some inflammation. I mean nothing. Said everything looks good.

Dr. O., I am back to my original, wacky theory.
We know we have a right front suspensory lesion. Is it possible that he has been sore on that for so long, that he is sore in his left hind from trying to protect/compensate for up front? He has been hopping off of that right front since December. (Right before his third suspensory strain in January.)

My other question, which the surgeon admitted is puzzling too, is why didn't his stifle repsond to the injection of HA/steriod they gave him in May, if there is nothing seriously wrong with it?

The plan is as follows: he is going to have three more weeks of stall/run rest. I am going to overdo it this time to make sure that suspensory heals. He is also getting shockwave therapy for that. Three weeks from now they will inject the stifle with a mixture of Legend, Adequan and a different type of steroid than they used before.
We will see if that does the job and then go from there.

I feel like this is good news, I guess?

Mary
Moderator:
DrO

Posted on Saturday, Jun 21, 2003 - 9:11 am:

Sounds better than a torn ligament!
DrO
Member:
Caymie

Posted on Saturday, Jun 21, 2003 - 10:04 am:

Dr.O.,
My thoughts exactly!!!! I am cautiously optimistic that once that suspensory heals up, he's going to be OK. And like I told Dr. Trotter, Caymann never does anything by the book:-)

Mary
Member:
Caymie

Posted on Saturday, Jun 21, 2003 - 8:12 pm:

Dr. O.,
What do you think of the idea of reinjecting Caymann's stifle with the mixture of Legend, Adequan, and Triamcinolone? (They used Depo last time). Any theories as to why the first injection didn't solve the problem since the arthroscopy didn't reaveal anything except inflammation?
Any ideas as to anything else that could be going on back there?

Thanks,
Mary
Member:
Caymie

Posted on Sunday, Jun 22, 2003 - 2:35 pm:

Also Dr. O.,
What do you think about trying Caymann on a course of Bute for a couple of weeks to see if that doesn't help the stifle? Since he is going to be resting anyway, would it be worth a try? Would you give him two grams once a day?

Thanks,
Mary
Moderator:
DrO

Posted on Sunday, Jun 22, 2003 - 8:54 pm:

I think both of these ideas have merit but what do the folks who have actually examined your horse and horses stifle say. These ideas and questions need to be discussed with the veterinarians who can examine your horse Mary.
DrO
Member:
Cassey

Posted on Sunday, Jun 22, 2003 - 9:53 pm:

Hi Mary,
When my horse was lame in the winter, the vet suggested no bute; he said that if you mask the pain, they might overuse the area, which is the exact opposite of what they should be doing. Interesting, eh? I realize you are thinking of the antiflammatory properities; too bad you couldn't get one effect without the other.
Member:
Caymie

Posted on Sunday, Jun 22, 2003 - 11:26 pm:

Hi Dr.O,
OK-that seems reasonable. I will ask about the bute when I call CSU tomorrow with some other questions. I was thinking of doing both-trying the bute for two weeks, and having them go ahead and inject the stifle again in three weeks. I'll keep you posted.

Thanks,
Mary
Member:
Caymie

Posted on Sunday, Jun 22, 2003 - 11:46 pm:

Hi D. Barry, (sorry I don't know your first name:-)
You make a good point about the bute-we have not given him bute in the past for his suspensory injuries for that very reason. However, he is stall/paddock resting at this time and his stifle was arthroscopically scoped on Friday and they found nothing there. So, I guess I am less worried about masking a soft tissue injury, because there doesn't appear to be one:-) I will check with the surgeon tomrrow however.

Mary
Member:
Caymie

Posted on Monday, Jun 23, 2003 - 1:29 pm:

Dr. O.,
Well, we are going to try both. The two weeks of bute and then the injection one week later. All the while he will continue resting. Hopefully, he will be sound again in his stifle. And then he will begin a controlled (HA! he's a Holsteiner) exercise rehab program for his suspensory. Most likely with some sedation so I don't end up in a rehab program:-)I don't anticipate turning him out in thhe big pasture for 12 more weeks or so. But we are hand walking, and he loves that.

Mary
Member:
Caymie

Posted on Thursday, Jun 26, 2003 - 11:11 pm:

Dr. O.,
Is injecting Adequan into a joint a good idea? What about mixing it with Legend and a steroid?
Caymann's stifle was injected on May 12th, with HA and Depo. They want to try a mixture of Legend, Adequan and Triamcinolone this time. It will be a little over eight weeks since his last injection. Just wondered what you thought about that. I have him on 2 grams of Bute a day for two weeks for now.

Mary
Moderator:
DrO

Posted on Friday, Jun 27, 2003 - 5:53 am:

For extensive information on Adequan and Legend see Equine Medications and Nutriceuticals » Anti-inflammatories, Steroids, and Arthritis Treatment » The Joint Protective Treatments.
DrO
Member:
Caymie

Posted on Friday, Jun 27, 2003 - 9:05 am:

Dr. O.,
Well, I have read the article that you suggested and I must say I don't find this idea all that reassuring. For several reasons: that joint was just injected eight weeks ago. We have already put a little steroid in it once. And, that article doesn't appear to have a favorable opinion of injecting Adequan into a joint. Or mixing it with other medications. The higher risk of infection scares me. And do we really need to inject a joint that doesn't appear to have anything wrong with it other than a little inflammation? When was that article written?

Questions: How about seeing how is stifle looks after this two week course of Bute and some more rest and then deciding? What do you think about just trying a series of IV Legend or IM Adequan
instead of injecting the joint? For joint inflammation which medication would you recommend? Or should I try both?
Moderator:
DrO

Posted on Saturday, Jun 28, 2003 - 6:03 am:

The articles are not static Mary, they are continually updated and edited as new information is gleaned. That particular article was last updated less than 3 months ago.

For acute joint inflammation I like Legend and steroid injected into the joint and I have repeated it in as little as 2 months, but I cannot say if that is the correct treatment for your horse. I continue to recommend that you find someone who you trust who can look at the horse to make these decisons Mary.
DrO
Member:
Caymie

Posted on Saturday, Jun 28, 2003 - 10:32 am:

Dr. O.,
I will talk to my ambulatory vet about it, since he is the one I trust the most, and he is the one who will be doing the injection. And I am going to wait and see how his stifle looks after these additional three weeks of rest and two weeks of Bute.

Mary
Member:
Suzeb

Posted on Saturday, Jul 5, 2003 - 10:06 am:

Hello Mary,
I am curious about the Cetyl M product you have Caymann on. Do you feel this is working or is it hard to tell, given all the stuff that is going on with Caymann right now? Thanks. Susan Bilsky
Member:
Caymie

Posted on Sunday, Jul 6, 2003 - 10:31 pm:

Hi Susan,
Yes, I am very pleased with the Cetyl M. It is a joint supplement that I purchase through my vet at CSU. It is expensive, approximately $90.00-$100.00 a month. (His Royalty has to have three scoops a day because he falls under the category of "large horse.") Because he had OCD surgery in both hocks and stifles, I have gone full guns on his maintenance. He also receives a Legend and Adequan injection monthly. However, I should also point out that Caymann has been essentially sound in his joints in his hind end since his surgery. (I know it might not seem that way with all of his problems, but his hind end lamenesses up until now have all been due to accidents on his part). So, I don't really feel I can comment on how effective the supplement would be for a horse with joint issues/arthritis. But I definitely saw an improvement in his hock action once I started him on it. There is a website I believe www.CetylM.com. And since they arthroscopically scoped is stifle and found nothing wrong, (suregeon said joint looks beautiful) I have to believe that the product has been effective. Hope this helps.
Mary
Member:
Suzeb

Posted on Monday, Jul 7, 2003 - 12:27 pm:

Hello Mary,

Thanks for your information. I know the cost is going to be dear, if I can obtain it up here in Canada. I guess that is the price you pay for a pain free horse. Laser's new shoes seem to be working very well for him as he had long toes and underrun heels. How is Caymann responding to his new shoes, or is it hard to tell with all the other things going on? Cheers, Susan and Laser
Member:
Caymie

Posted on Monday, Jul 7, 2003 - 7:06 pm:

Hi Susan,
I think they ship the Cetyl M all over the country so I don't know how much worse shipping charges to Canada would be. But if it wasn't expensive, would Laser or Caymann be interested? I think not. He is doing great with his new shoes. He has eggbars (no wedge)on his front feet with equithane for extra sole cushioning. And regular steel shoes on back. My farrier is doing an EXCELLENT job. His feet look beautiful. Finally. He has been resting for almost eight weeks now. The main problem has been the lesion on his suspensory. He looks strong and sound to me the little bit I have let him trot on the lounge on our walks. I am anxious to hear what the vet has to say about how stifle looks. He will be out within the next week to look at him. I am going to give him some extra time to heal even if everything looks good. Maybe an extra months since he has had so much trouble with this. And I am going to bring him back with a controlled exercise program this time. I am going to start im back under saddle first, and then turnout. I'm glad Laser is doing well in his new shoes. What are they?

Mary
Member:
Caymie

Posted on Sunday, Aug 3, 2003 - 5:48 pm:

Hi everyone,
Just wanted to give you an update on Caymann.
He has been stall resting since May and hand walked daily. I just started walking him under saddle yesterday. I couldn't resist a few trot steps to see if he was sound. He is sound and I am very encouraged. I think that finally having the rest he needed for his suspensory lesion has taken care of the problem. He didn't hop, shuffle or take one off step. So now I am going to continue his rehab with controlled (HA!) exercise under saddle while continuing to monitor the suspensory lesion with ultrasound. I am using Dr. O's rehab protocol as a guide. And my horse will tell me everything else I need to know as we progress.

Mary
Member:
Caymie

Posted on Sunday, Aug 3, 2003 - 5:52 pm:

By the way Dr. O.,
I decided against letting them reinject his stifle. (They wanted to use Adequan and that made me nervous). I tried a four week series of Legend and IM Adequan instead. I was never convinced that the stifle was his primary problem and when they scoped it and found nothing, (surgeon said joint looked beautiful)I was even more convinced. I will forever believe that because he was sore for so long on his right front, that he became sore on his left hind as well. Maybe a crazy theory, but it's all I've got:-) He has been a lot more sore on that stifle before and he never hopped around like he had been ever since his suspensory problem got worse.

Mary
Moderator:
DrO

Posted on Monday, Aug 4, 2003 - 10:36 am:

I will keep my fingers crossed Mary, Good Luck.
DrO
Member:
Caymie

Posted on Monday, Aug 4, 2003 - 11:28 am:

Thanks Dr. O.
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