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  Discussion on Treatment protocol for chronic injury
Author Message
Member:
shanson

Posted on Monday, Mar 19, 2007 - 8:38 pm:

I read your recent updates around chronic heel pain synDrOme and have a question about the efficacy of Legend/Adequan injections. I have a mare with chronic injury/injuries to left front foot due to improper farrier work over an extended period of time. MRI results a few years ago characterized injuries as:

Findings: There are numerous abnormalities. The most significant abnormality appears to be tearing and an abnormality to the medial collateral ligament of the distal interphalangeal joint. The lateral aspect appears normal and the medial aspect is thickened with an increased signal intensity indicative of immature collagen. There are adhesions present between the suspensory ligament of the navicular and the dorsal aspect of the deep digital flexor tendon. There is an abnormality in the annual ligament around the deep digital flexor tendon on the medial aspect at the level of proximal P2. It would appear that the most significant lesion is the collateral ligament abnormality on the medial aspect of the distal interphalangeal joint. However, the adhesions between the deep digital flexor tendon and the suspensory ligament may also be contributing to the animal’s lameness.

Conclusions: Chronic tearing abnormality of the collateral ligament on the medial aspect of the distal interphalangeal joint. Adhesions between the deep digital flexor tendon and the suspensory ligament of the navicular. This change is also more pronounced on the medial aspect.

This all sounds pretty bad, but I laid her up for 9 months after this MRI and then brought her back slowly. Except for two short episodes, she's been sound for fairly heavy use on good footing for the past year. I use a top-notch farrier, keep her in bar shoes, and don't ride her hard on bad footing or rocks. This is a phenomenal mare worth the extra effort.

My question concerns the monthly Legend/Adequan injections I've been giving her at the advice of a respected lameness vet in our area. I missed the shots one month recently and she got sore, but her workload also increased about that time so that could have accounted for it.

However, after reading your articles, I'm not so sure these expensive monthly shots are really making a difference with her. She has no other health or soundness issues.

1. Can you see any reason, based on the MRI results, for either of these injections helping her? I've assumed the anti-inflammatory characteristics of the Legend might be making a difference.

2. If I wanted to try discontinuing them one at a time, would you discontinue the Adequan or Legend first?

Thanks! ...Sharon
Moderator:
DrO

Posted on Tuesday, Mar 20, 2007 - 7:12 am:

Hello Sharon,
The basis for help would be attenuating the effects of DJD of the coffin joint / navicular bursa that might form secondary to the damaged soft tissues. For instance the collateral ligament is incorporated into the DIP (coffin) joint capsule so damage to it will almost certainly induce a synovitis and possibly a secondary DJD of the coffin joint.

But as you have read, there are still questions whether these products are actually doing much good when used systemically. If you wanted to experiment with quitting I think I would start with the Adequan, as the support for systemic Legend is better, while maintaining an even work load. If several months go by then you try without the Legend. I would be using oral chonDrOprotective drugs (see article for recommendations).

As you have run into already a problem with interpretation is the normal lameness ups and downs of such chronic injuries problems and that these type injures tend to be progressively worse over time. A good diary helps with understanding.
DrO
Member:
shanson

Posted on Tuesday, Mar 20, 2007 - 12:09 pm:

Oh, I see now that all this info. I've asked about is in the article, "Arthritis and DJD: An Overview." I hadn't thought of her injuries as arthritis/DJD.

Having read that article, I wonder now if she'd do just as well on the oral chonDrOprotective drugs and bute for riding on weekends? She responds well to bute, but I've been reluctant to use it too much for fear it would mask pain and she'd overdo it.

Longer term, if her condition deteriorates, I've thought to put her on a pasture board nearby where the land is flat and sandy. I realize you don't have a crystal ball, but what do you reckon are the chances of her being able to go barefoot on a pasture board with her injuries? Of course, she'd get regular trims by competent farrier.

Thanks very much...sharon
Moderator:
DrO

Posted on Wednesday, Mar 21, 2007 - 7:56 am:

Her injuries are not directly DJD Sharon, but they are soft tissue injuries to the structures intimate to a joint and within a bursa. These can cause acute synovitis which can lead to osteroarthritis (DJD).
DrO
Member:
shanson

Posted on Wednesday, Mar 21, 2007 - 10:03 am:

Yes, I understand. Thanks very much.
New Member:
mlouise

Posted on Tuesday, Dec 23, 2008 - 2:47 pm:

Sharon when you say you laid up your horse was it stall rest and what else did you do?
I was told 6- 9 months stall rest only and shock wave 3x every 3 weeks.
I can't afford that. I was just wondering what you did.
Thanks
Member:
shanson

Posted on Wednesday, Dec 24, 2008 - 12:24 pm:

Hi Maryann,

Yes, it was stall rest. I put her at a facility set up for it. She was in a very large covered stall (maybe 15-20' x 10'), part of which was open sided (corral panels). There was a gelding laid up in the stall next to her and they shared a round bale. Footing was sand.

They took her out daily to groom and handle her. It was on the expensive side, but a bargain considering the level of care she got. I didn't have much choice as there was no way I could do this myself because of the daily care commitment.

Just to update folks on this mare, she is doing really well on a pasture board. I ride her a couple of times a week and she's held up well. I kept her in bar shoes for a while, but about 6 months ago pulled her shoes and she's done super well barefoot. In fact, she's doing better barefoot because the foot wears more so that her foot stays shorter, better balanced, and she doesn't get too long in the toe between farrier visits. Pasture is flat with sandy soil. The KEY to keeping her sound has been monthly Legend injections. And only working her on good footing. I'm delighted that she's doing this well considering the extent of her injuries.

Bottom line for those in this position, I made a lot of mistakes in the early months of this mare's injuries and, for that reason, she will always have to be managed carefully. But, she's doing well and is a pure pleasure to ride. I have high hopes of her holding up for a very long time!

Maryann, I guess if I'd not had the $ to bring this mare along the way I did, I would have found a nice quiet pasture board on good footing for her with companions, and turned her out for a year or so, with regular COMPETENT farrier work (every 5 weeks), and hoped for the best. This is what a lot of folks do and many horses heal up enough to become usable.

If you can afford Legend injections (and your vet agrees), I'd go for them too. As I said, Legend has made the difference with my mare. It's expensive, but I worked out good pricing with my vet and do the intravenous injection myself to save %.
Moderator:
DrO

Posted on Friday, Dec 26, 2008 - 8:01 am:

Sharon, while I am not contradicting that Legend made a difference I would like to point out that your horse got better and it is uncertain what difference would have been seen without the Legend injections. It is important to emphasize that it has been recently shown that with these type injuries it is the enforced rest that is critical and the effects of IV Legend still remain largely conjectural and at best small.
DrO
Member:
shanson

Posted on Friday, Dec 26, 2008 - 3:50 pm:

I should have been more clear. I realize that the efficacy of Legend is conjectural and, for that reason, I should not give advice to other members.

In my mare's case, though, it has been over 2 years since I finished her layup and while she healed pretty well, she did not heal completely. Without proper management, she will get sore in that foot.

I've experimented with different protocols, including less-frequent Legend injections. What I've found is that, with no other changes in her management, she will get sore and stay sore if she does not receive a Legend injection every 30-60 days. And she goes sound within a few days of receiving the injection. I've assumed that its anti-inflammatory characteristics make the difference with her.
Moderator:
DrO

Posted on Friday, Dec 26, 2008 - 5:07 pm:

Sharon, the advice was fine it just is my job to be sure they get the "whole story". I would like to know if you change your opinion on this however.
DrO
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