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| HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Lower Limb » Suspensory Desmitis, Strain, & Sprain » |
| Discussion on Does ultrasound have to return to normal for soundness to return? | |
| Author | Message |
| Member: Wolfydoc |
Posted on Saturday, Mar 5, 2005 - 1:25 pm: DrO,My 5 yr old TWH was diagnosed 7 months ago via exam, nerve blocks, and ultrasound with a right front AND left rear proximal suspensory desmitis. He is quite sickle-hocked. We followed a strict rehab program of stall rest plus controlled exercise for the rest of the summer and into fall. At 3 months post diagnosis his ultrasound looked significantly improved, and we were to start short increments of gaiting along with the walking we were already doing under saddle. However, here in Nevada we had an awful winter, and he had no riding for 2 months straight but he did get turnout in a 24 x 36 paddock during those months. I had him rechecked and re-ultrasounded when we could start riding again, and again, his ultrasound looked improved but still not normal. On a 14 foot lunge line you could not see any lameness. My vet felt he needed to put a little stress on the ligaments in the form of gaiting for short periods, in order to get the fibers of the ligaments to line up and strengthen. Well today, my roundpen is finally usable again - snow is gone and footing good. So I free-lunged Elvis in there for a few circles just to see what he looked like, since he lunges MUCH better that way. He does a beautiful extended trot, and to my disappointment, I could STILL see his lameness going to the left, and only to the left, as it was 7 months ago. I am so bummed. Now here is my question after my long dissertation! Is it expected that he would not be sound since his ultrasound is not normal yet? I just don't feel right about this whole thing, like the diagnosis was missed or else he just has a poor prognosis even though his very first ultrasound was not horrible, i.e. not a full tear, just a mild to moderate sprain. I love this horse dearly - we are very bonded, and I've only had him for 19 months. Thanks so much. I have a call in to my vet about my findings today, but he won't be available for a few days, and I'm just so down in the dumps about this. |
| Moderator: DrO |
Posted on Sunday, Mar 6, 2005 - 8:10 am: Not neccesarily, after this much time I would have the lameness reassessed to be sure it still is the suspensory. No since worrying until you know whats wrong. If you continue to remain worried about the diagnosis: get a second opinion.DrO |
| Member: Wolfydoc |
Posted on Sunday, Mar 6, 2005 - 10:14 pm: Thanks, DrO,I will talk to my vet tomorrow and formulate a game plan, maybe repeat nerve blocks. Assuming the response is still the same, is it then likely that he just has a poor prognosis for return to soundness? (I always have the option to take him to UC Davis for a second opinion.) Thanks again |
| Moderator: DrO |
Posted on Monday, Mar 7, 2005 - 6:08 am: I cannot say what the prognosis for your horse is Cynthia without seeing the horse. However prolonged or recurrent lameness from suspensory desmitis does worsen the prognosis in general.DrO |
| Member: Gillef |
Posted on Monday, Mar 7, 2005 - 1:45 pm: Hi CyhthiaMaybe it is easier for me to share with you my experience of proximal suspensory desmitis as I am a fellow owner and not a vet. I shall try to cut this long story short. My part bred arab mare (born 1991) was diagnosed in 2002 August as having Chronic suspensory desmitis in her right hind leg with an abnormality on ultrasound in her deep flexor tendon. This was following on from a sesamoidean ligament sprain and tendonitis which was resolved with medicating the tendon sheath. The advice given to me by the "Dick" vet (University of Edinburgh Vet. College) was to take her home and have a foal from her. I did not want a foal as I do not have the facilities or the patience so I spent a year grieving for my lost riding relationship with her and embarked upon a rehab programme as outlined on this site and brought her back into work as a hack (trail horse) and even competed in a western show (trail and pleasure classes) here in Scotland. Last year I bought yet another horse to replace her in the "Endurance" field. Just before Christmas she twisted a (raised heel) shoe off and and soon showed signs of her old lameness. I have taken her back to the university to have a lameness workup as they had suggested that she could be made sound/ comfortable with surgey. They found that she was no longer lame from the suspensory desmitis but they are confident she will come sound after medicating the tendon sheath again. From my reading, research and conversation with vets front leg suspensory desmitis has a 97% recovery rate whereas hind leg desmitis has only 18% recovery rate but even if it does not resolve itself your horse may be returned to soundness via neurectomy and fasciotomy. Probably expensive but cheaper than a new horse and best of all you keep your old friend Best Wishes Gillian |
| Moderator: DrO |
Posted on Monday, Mar 7, 2005 - 6:38 pm: There may have been some miscommunication Gillian about treatment options. Neurectomy is not a alternative for suspensory desmitis: the nerving has to be done too high for safety and continued agressive use of a inflammed ligament will eventually result in rupture.DrO |
| Member: Wolfydoc |
Posted on Monday, Mar 7, 2005 - 10:55 pm: Thanks Gillian and DrO for the info. I'm still waiting to hear from my vet, but I'm feeling like I need to get a second opinion from UC Davis for both Elvis' sake and my own.cindy |
| Member: Gillef |
Posted on Wednesday, Mar 9, 2005 - 9:58 am: No miscommunication. This procedure is for proximal suspensory desmitis of long standing which has not resolved after conservative treatment.The continued pain is believed to be partly compartmental in nature. Only the plantar branch of the nerve is cut and the releasing of the fascia helps to relieve pressure. By this stage acute inflammation has subsided. The genteman I am dealing with says there are great results in over a hundred cases and no problems on being ridden again.I know just how Cynthia is feeling and wanted to Share some hope with her--even our wonderful vets cannot predict the future and can be surprised by the results if nature is given time to heal. Good Luck Gillian |
| Moderator: DrO |
Posted on Wednesday, Mar 9, 2005 - 11:46 am: Who is doing this work Gillian? After your last post I went to the most recent lameness text I have (Dyson 2003) and went to pubmed which is current to last month in the veterinary and scientific literature and cannot find mention of any such procedure.DrO |
| Member: Gillef |
Posted on Wednesday, Mar 9, 2005 - 3:14 pm: The gentleman I am dealing with is Mr. Todd Booth CERT ES(ORTH) MACVS DIP.EVCS MRCVS (Hospital Director) LARGE ANIMAL HOSPITAL, THE ROYAL (DICK) SCHOOL OF VETERINARY STUDIES,THE UNIVERSITY OF EDINBURGH . SCOTLAND.He describes it as" a very straightforward piece of surgery" but luckily I won't have to get any more familiar with it. |
| Moderator: DrO |
Posted on Thursday, Mar 10, 2005 - 8:49 am: Thanks for the heads up! I have emailed Mr Booth to get a description of the procedure and will add what I find out to our article.DrO |
| Member: Caymie |
Posted on Friday, Mar 3, 2006 - 4:15 pm: Hi Gillian,I am very interested in learning more about this surgery as my vet and I were just discussing this very procedure the other day. Does the horse have to go under general anesthesia I assume? Have they had good success with returning some horses to soundness that have chronic suspensory desmitis in the hindlimb? Where could I go to find out more information on this? Thanks, Mary |
| Member: Caymie |
Posted on Friday, Mar 3, 2006 - 6:09 pm: Dr. O.,Were you ever able to obtain any additional information about this surgery? If so, how might I access it? Thanks, Mary |
| Moderator: DrO |
Posted on Saturday, Mar 4, 2006 - 1:48 pm: Hello Mary,As far as I can remember I did not receive an email back. I went to see if there had been any published studies since last year and do not find any. DrO |
| Member: Caymie |
Posted on Saturday, Mar 4, 2006 - 3:34 pm: Dr. O.,I realized while reading your reply that I have failed to give you the latest update on our diagnostic journey. When I last posted we had just injected Caymann's SI joint. The vet was not seeing as much of a response as he expected if that were the primary source of the lameness. So, he had me stall/paddock rest him to see if that would change anything. Within eight days of stall rest he improved dramatically. No more toe dragging, was moving forward much more willingly. So, I took him back for a recheck. The vet agreed that he was much improved, but was still not convinced it was his SI joint. So, given our history of lower hock joints blocking out, and the injections not restoring him to soundness, he blocked him out at the origin of his right hind suspensory ligament, and darn it if he didn't just trot off sounder than we have ever seen him. So I am guessing that it was the rest that improved him more so than the SI injection? They ultrasounded the ligament and didn't really see much of anything. The radiologist said the results were equivocal. He has had three shockwave treatments, continues to be on stall/run rest and will begin swimming on a treadmill next week if we can convince him to do it. I of course have a new set of questions for you- 1. In your experience, will a suspensory origin lameness sometimes block out with the block of the lower hock joints? 2.Is it unusual to have a grade 2 lameness on a hind suspensory ligament but no evidence on ultrasound of an injury? 3.Would you expect that this is a chronic injury or more of an acute one if he improved that much with just eight days of resting? (He had been allowed turn out in the pasture prior to all of this, which is not exactly resting for him). 4.Can a chronic hind limb suspensory injury go on for a year or two, or would you expect him to be much worse off clinically and ultrasound wise if this were more of a chronic condition? 5.He also has a mild hock arthritis in that right hock as well. Can these two problems sometimes feed off of each other? That is one of the reasons that this has been such a challenge to diagnose. And I am still trying to reconcile the results of the block to the suspensory with the improvement that resulted from injecting the hock, although it never made him sound. 6. He improved fifty percent after the first shockwave treatment, (they were done once a week for three weeks). Do you think that is a good sign as far as the potential for him to heal from this? That is why I was inquiring about this surgery. My vet just came back from a conference where Sue Dyson discussed this very procedure. He was going to try and find out more information. Of course, I am wanting to try the more conservative route first. Thanks, Mary |
| Moderator: DrO |
Posted on Sunday, Mar 5, 2006 - 11:32 am: 1) No but this is not to say it does not happen. We do know if we block the lowest carpal joint that it may also block the origin of the suspensory. I have not seen a similar study with the hock however so the question remains open.2) No but this is because of limitations of the machine and operator, a good enough machine and a good enough operator would probably see something. 3) 8 days rest may substantially improve either. 4) If not substantially reinjured it may not worsen with time. 5) I am not sure what you mean by feed off each other but they certainly could occur concurrently. 6) The shockwave causes some temporary nerve disruption so causes a local anesthesia. As a result it does not necessarily mean there is healing. On the other hand it is somewhat localizing of the lesion. What did Sue Dyson say about the procedure. DrO |
| Member: Caymie |
Posted on Sunday, Mar 5, 2006 - 12:54 pm: Hi Dr. O.,Thanks for your replies. I am trying not to fixate on the issue of his hock arthritis and here is why. Back in October when the vet injected his right hock, he was better than he had been in a long, long time. Even though that injection did not return him to soundness, he moved almost normally and was happily being ridden under saddle. Another curious thing is that he had been sticking his tongue out of his mouth to the right side, (which is not a normal behavior for him), for quite awhile. I had always suspected that it was a reaction to pain somewhere. The minute that hock was injected, he put his tongue back into his mouth instantly. I couldn't get him to stick it out, where as before I couldn't get him to put it back in no matter what I tried. He went along that way for about six weeks until he started sticking it out again, and was acting quite sore. I think I have told you in my previous posts that he had twice blocked out to the lower hock joints. Once last August, and again in October. I am trying to reconcile the response I got under saddle from the hock injection, with the response I saw when the vet blocked out the origin of his suspensory. And remember too that he had two full blown reactions to those hock injections. Bear with me while I ask some wild and wacky questions, because this is driving me nuts. 1)Could the hock injection have quieted down the inflammation from the origin of the suspensory as well? Could a block to the origin of the suspensory somehow diffuse to the lower hock joints? When hock arthritis and a suspensory origin injury (with no ultrasound changes) occur at the same time, how do you differentiate between the two? 2)Could the origin of the suspensory somehow have been damaged in the process of the reactions he had to the hock injections and/or if the injection didn't make it into the joint? 3)Could his hock arthritis be much worse than the bone scan is indicating? The hock did light up on the scan, but they called it mild. And we had just injected the hock six weeks prior to the scan so I don't know if that is what was causing it to light up or if there was still inflammation there even after the injection. 4)How long does the anesthesia effect last from the shockwave? I was encouraged by his response to the first treatment, but maybe what we were really seeing was the anesthetic effect? Our plan is to rest him for three more weeks following his third shockwave treatment. If we do not see continued improvement, we are going to radiograph the hock again since the last radiograph was taken in August. We may consider injecting the hock again based on the radiograph, if he does not continue to improve. If he continues to improve, then I suspect we will continue to rest him for the suspensory ligament. Does that seem reasonable? My vet is one of the lameness surgeons at Colorado State University. He is going to try and find out more about this procedure that Dr. Dyson described. It sounds alot like what Gillian was talking about in her post, with the idea that there is some type of compartmental component that causes continued pain. I will let you know what my vet finds out. Thanks so much for your thoughts. Mary |
| Moderator: DrO |
Posted on Sunday, Mar 5, 2006 - 6:35 pm: 1) Unknown, see the response to local anesthesia above. We do not know at this time if we see such results. Until we know differently I do not confuse the two: if it blocks out in the hock it is the hock, if it blocks out in the suspensory it is the suspensory. If both blocked it out completely, something I have never had happen, you have to look for other evidence of disease to make your best judgement.2) Unlikely. 3) Yes or not as bad, scans do not well correlate with severity of problem. 4) For more on this effect of shock wave see Equine Diseases » Lameness » Treatment Methods » Extracorporeal Shock Wave Therapy. DrO |
| Member: Caymie |
Posted on Sunday, Mar 5, 2006 - 7:07 pm: Hi Dr. O.,Only my horse would block out to his hock and origin of suspensory with no evidence on ultrasound to point us in one direction or another. And right now I have more radiographic evidence of disease in his hock, as opposed to the suspensory ligament. I believe that the vet blocked the lateral side of the origin of the suspensory, so I was just wondering if that block could affect the lower hock joints as well. I read over the article on shockwave therapy. The analgesic effect can last longer than I thought. Would really bad hock arthritis improve initially with stall rest as opposed to turnout? Just out of curiosity, what would you do in a situation such as this? Thanks, Mary |
| Moderator: DrO |
Posted on Monday, Mar 6, 2006 - 6:54 am: It might if there is a lot of acute injury to cool out. I would wait to see what the final outcome of the shockwave would be, after all it has made a remarkable change in the appearance of the lameness, it just remains uncertain why.DrO |
| Member: Caymie |
Posted on Monday, Mar 6, 2006 - 9:08 am: Dr.O.,Sounds like a good plan to me. He had his final treatment last Thursday. In the meantime he is going to start walking on a water treadmill to try and start getting back into shape. If it is his suspensory ligament then that will help with that too. The vet will look at him in three weeks and we will go from there. Thanks for your thoughts-this has been a most frustrating situation. But I suspect that with a little more time, we will know in what direction to proceed. I'll keep you posted. Mary |
| Member: Wolfydoc |
Posted on Tuesday, Mar 7, 2006 - 12:44 am: For what it's worth, both my vets (one a board certified surgeon who does lots of lameness work and is well-respected at UC Davis) feel that a high suspensory desmitis can be misdiagnosed as a hock problem. They feel that it is not uncommon for local anesthestic blocks in the lower hock to diffuse to the proximal suspensory and give a false diagnosis. I can call them and ask for more detail, since I was told this a year ago and in a bit of shock at the time about my horse having a serious injury.BUT, folks, the great news is, Elvis is recovered and out hauling butt on the trails. I will tell you this also, although it's on a different note, I think it is important. I have taken all my horses barefoot (I am in training with the American Asso. of Natural Hoof Care Practitioners), and I truly believe it can only help to have a horse's hooves functioning the way they are supposed to, absorbing the concussion and compression forces as nature intended them too, instead of being cast in a metal shoe that causes those forces to be transmitted up higher in the leg. Furthermore, after studying about proper natural trimming, I know now that Elvis's hooves had been trimmed unnaturally, with the classic, all-too-common, high heel, long toe. Surely this cannot have helped his situation, and may have played a part in causing it. I have NEVER seen him feel so frisky out on the trails as he does now, in bare feet. And it makes sense to me to give our horses the best chance at soundness they can possibly have. Tomas G. Teskey, D.V.M., who has articles about this on the Easyboot site, states this amazing statistic: 85% of all lamenesses in his practice over the last several (maybe 10, I can't remember) years have been in shod horses, YET ONLY 48% OF HIS PATIENTS ARE SHOD! Now maybe the shod horses get worked more, and lots of the barefoot ones are bare because they aren't being worked, I don't know, but it still is something to ponder. I better get off this soapbox because it's not the issue here. Cindy |
| Moderator: DrO |
Posted on Tuesday, Mar 7, 2006 - 7:50 am: Thanks DrN,I am sure it gives Mary more to think about. If you can contact them I wonder if they are doing the neurectomy of the nerves to the suspensory? Congrats on Elvis and sorry about the highjack of your discussion. How did the second opinion go, I don't think I have seen the results? DrO |
| Member: Caymie |
Posted on Tuesday, Mar 7, 2006 - 9:05 am: Hi Cindy,That is exactly what my wonderful vet (board certified as well)believes is happening here. He twice blocked out to his hock. We injected the hock twice, he improved some, but the injections never made him anywhere near sound. This has been a diagnostic nightmare and my vet has done a great job. I am learning patience that I didn't know I had! Anyway, we know that there was some pain in his hock, as he has mild arthritis there. My horse went totally sound to a lateral plantar nerve block. The vet said this is a pretty specific block for the suspensory. He had his third shockwave treatment last Thursday. He is going to rest for three weeks. I am handwalking him and he starts the water treadmill today. (If he will agree to it-hates water). In three weeks we will look at him again. Depending on the amount of improvement we see, we may consider injecting his hock again to see if that helps now that we have dealt with the suspensory issue. The reason we are considering the fasciotomy/neurectomy is that Caymann's lameness is quite a bit worse for what we are seeing on the ultrasound. He has a clean ultrasound of that ligament and the ultrasound was done at the teaching hospital with a good machine and experienced operator. And if this is indeed the source of the lameness, it is very chronic as he has not been quite right for a very long time, and it has been getting worse while we have tried to diagnose him. The thought is that the pain has a compartmental component to it. He would do the nerving of the lateral plantar nerve as well, which is the nerve that he blocked out when he went sound. He is not concerned that by removing the pain that Caymann will further damage the ligament, since the ligament does not really appear to be damaged in the first place. I am hoping it won't come to this, I would rather just have to rest him longer than put him through surgery, but that may be his only option if the shockwave/rest doesn't heal it. Hopefully, we will have more evidence to solve the Holsteiner crime in three weeks. I am counting the days............... So glad to hear that Elvis is doing well. Enjoy a few trail rides for us! Thanks for your thoughts, it is very helpful to know that there are other vets who have had this experience with the hock/suspensory dilemma. We'll keep you posted. Mary |
| Member: Caymie |
Posted on Tuesday, Mar 7, 2006 - 9:06 am: Cindy,Any further information you can glean from your vet regarding this situation would be greatly appreciated by me! Do they have any thoughts on the fasciotomy/neurectomy? Thanks, Mary |
| Member: Wolfydoc |
Posted on Wednesday, Mar 8, 2006 - 12:09 am: I will talk to Dr. Reese Hand, my vet, asap. Give me a few days as I am leaving tomorrow for the Amer. Asso. of Natural Hoof Care Practitioners Conference. I am curious too about the neurectomy. Neither of my vets mentioned this procedure to me.I didn't get a second opinion as he continued to slowly - and I mean slowly! - improve once he was back to controlled riding after a horrible snowy two months spent stuck in his stall. The other thing that helped is Dr. Hand showed me exactly where to palpate for any pain so I check before and after every ride. It really helps to know your own horse's reaction and just get familiar yourself - as well as get him used to being deeply palpated. Some horses just don't like it at first, even though there's no pain there, but once you do it routinely, you can really assess how your horse is doing right away, without a trip to the vet. I do think there is a compartmental component to all proximal suspensory injuries simply because of the anatomy there - it is "trapped" between several relatively non-mobile structures, so if it has any swelling at all, it can be pretty painful, yet a couple days rest and a decrease in swelling can make a dramatic improvement in the horse's comfort level. Enough to make you think it is all healed, when in reality it is not. Some of my friends think that instead of spending lots of money and stressing, just turn out a horse for a year or so, let him be a horse, and usually whatever is causing the obscure lameness (obviously ruling out things like fractures, infection, etc.) will eventually go away. As a vet and horse owner, I have a hard time with this one, but it works sometimes. Mary that thing with the tongue is really interesting!! Is he still doing it now? Cindy |
| Member: Caymie |
Posted on Wednesday, Mar 8, 2006 - 8:20 am: Hi Cindy,We tried the turnout thing for a year. He has basically been off for the past year while we have tried to sort out all of his issues. He was sound briefly last year at this time, but the minute I put him back into work, he started having trouble again. As much as I hate locking a horse up, I have never really understood how you could expect a soft tissue injury to heal with a horse turned out. Maybe if the horse is quiet, but mine is not. I assumed it was his hock, with rest the arthritis improved, with work it worsened. But now I am not so sure. Either this is a very chronic injury, (2-3 years in the making), or it has been his hock this whole time and the suspensory was injured within the last six months or so. Or both have been going on and now that we have dealt with the hock, we are seeing the suspensory. The fact that he appears to have some mild hock arthritis is certainly complicating things. Or maybe the radiographic finding of the bone spur is totally irrelevant in this case. I think the thought here is IF this is a really chronic injury that the pain may be coming from somewhere else, (compartmental pressure, the nerve)since his ultrasound looks so good. If it is that chronic, certainly all of the acute inflammation is gone at this point. If this is a more recent injury, then that might explain the lack of ultrasound findings. My vet has been palpating that leg for several months now. He cannot get ANY type of pain response from him at all, which he said is not unusual for a hind leg suspensory problem. Anyway, I am with you. I would much rather try the slow and non-surgical approach first. He has had three shockwave treatments and started walking on a water treadmill yesterday. As long as we see continued improvement, I will stick to this plan. How long did it take Elvis to heal from his suspensory problem? Yes, as long as he is in pain, he continues to hang his tongue out when you ask him to collect with a bit in his mouth. He NEVER used to do this. I take great comfort in the fact that he did put it back in for awhile following the hock injection. I think that once he is no longer hurting, it will no longer be an issue. I was actually talking with the vet who oversees the rehab program with the treadmill. She is a great field vet here and spent some time at Rood and Riddle doing an internship. She saw this type of injury in race horses quite a bit. The treatment of choice was to medicate the ligament with a steroid to get the horse back to racing. She confirmed our experience with the hock injection-it improves them about fifty percent for a short time. Which is exactly what happened to us. She also agreed with my theory that perhaps the steroid diffused to the ligament(much like the block does) and quieted down the inflammation enough that he was happier being ridden than he had been in a long time. Not a good long term solution obviously if you just keep riding the horse and stressing the ligament. Any information you could get from your vet would be great! Don't worry about the time frame. We're not going anywhere soon except back and forth to the water treadmill! Thanks so much for taking the time to talk with us. Mary |
| Member: Caymie |
Posted on Tuesday, Mar 21, 2006 - 7:40 pm: Hi Dr. O.,Caymann had recheck exam today and the vet downgraded him from a 2 to a 1 on the lameness scale! He has been walking on the water treadmill for two weeks, for five times a week. It has been two and half weeks since his third shockwave treatment. He has been stall/paddock resting for a total of twelve weeks. He has made the greatest progress following his third shockwave treatment and starting the swimming. The vet will look at him again in three weeks. Does this seem like a reasonable progression/time frame for healing to you Dr. O for a hind suspensory lameness? Can hind suspensory lameness sometimes take longer than three months? I am very pleased with his progress. Hopefully he will continue to improve. Thanks, Mary |
| Moderator: DrO |
Posted on Wednesday, Mar 22, 2006 - 8:36 am: Yes suspensory injuries can take longer than 3 months to heal. It is encouraging that there continues to be improvement.DrO |
| Member: Canter |
Posted on Wednesday, Mar 22, 2006 - 8:48 am: Yeah! Great news, Mary. I hope there's even greater progress at the next check in 3 weeks!Scratches to Caymann. Fran |
| Member: Caymie |
Posted on Wednesday, Mar 22, 2006 - 9:17 am: Thanks Dr. O and Fran. I really believe that this walking/swimming on the treadmill is doing wonders for his healing. We will continue to go for five days a week until our next check. Thanks for the good wishes Fran. Give Sparkles a kiss for us and email me when you have a second and let me know how YOUR riding is going. I will live vicariously through you for now!Mary |
| Member: Wolfydoc |
Posted on Monday, Apr 3, 2006 - 2:18 pm: Hey All,What about stem cell therapy for suspensory injuries? DrO, have you had any experience with this? Is there a reason it is not listed yet in the article regarding treatment options? I am not saying I personally know anything about this, but my vet is about to perform the procedure on my friend's horse who has a bad proximal rear suspensory injury. The company who develops the stem cells to be implanted at the site of injury is called Vet-Stem, www.vet-stem.com, and there is a list of references on their website from which you can get abstracts at least. I have not perused the articles yet, but I will be seeing my vet on this Wed. and will ask him more info regarding what kind of results they are getting. But I was wondering why it is not listed here as a treatment option - did I miss it? Thanks, Cindy |
| Moderator: DrO |
Posted on Monday, Apr 3, 2006 - 3:09 pm: Run a search on it Cynthia as this is a often and recently discussed subject.DrO |
| Member: Wolfydoc |
Posted on Monday, Apr 3, 2006 - 3:30 pm: DrO, I only found the posts under "Stem Cell Technology" under the Alternative Medicine section, and these were from a couple years ago, other than the last mentioning cost (Feb. 2006). I searched under "stem cell". Is there a better search term/phrase?C. |
| Moderator: DrO |
Posted on Monday, Apr 3, 2006 - 4:17 pm: Did you use the discussion by keyword search engine Cynthia? I come up with 20 plus. Be sure to set it to "and" (not "or") or you get many less significant hits.DrO |
| Member: Wolfydoc |
Posted on Monday, Apr 3, 2006 - 5:26 pm: Duh, sorry, DrO - I found them! Thanks a bazillion.C. |
| Member: Wolfydoc |
Posted on Monday, Apr 3, 2006 - 6:25 pm: Well DrO and All,I didn't see any articles listed on Vet Stem's site that evaluate equine adipose-derived stem cells as a treatment for suspensory desmitis - so I just called them. The vet there is emailing me the latest info in print, which was presented at some big International Symposium on Ligaments and Tendons or something like that, as well as something presented at the latest AAEP meeting (symposium?) by a vet named Dalgrin (sp.?). He said the problem they are having with getting their stuff printed in JAVMA (J. of the Amer. Veterinary Medical Asso.) is that JAVMA won't print anything regarding the efficacy of a "pharmaceutical" if it is not approved by the FDA. However the FDA doesn't have a position on stem cell stuff - they don't classify it as a pharmaceutical so there is no "FDA approval" that will occur, according to this vet. Anyway, I will read the info and report. Also if anyone wants me to send it to them, give me your email. Cindy |
| Moderator: DrO |
Posted on Monday, Apr 3, 2006 - 7:05 pm: I will check the proceedings Cynthia, I was there but missed this presentation. After you review this information it would be great for you to publish your thoughts here as a critical reviewer. I have not seen anything close to demonstrating clinical efficacy with this particular technique and tendon/ligament injuries in any specie in pubmed, but there is lots of conjecture.DrO |
| New Member: Luley |
Posted on Thursday, Apr 6, 2006 - 11:26 am: Hi Dr O and everyone else...am new to the site, and, so pleased I found it.My problem is a similar one to the discussion so far and if it is being posted in the "wrong" place, apologies and please will someone re-route it! I am still in a state of shock, now wearing off to utter misery following my visit to the vet yesterday. My 15 year old Danish dressage horse has been struggling with "performance" issues since last year (January 05). The first thing he was treated for was a stiffness on the left rein which was recommended by the vet....a physio treated him for several weeks with manipulation, stretching and deep muscle excersises which was never really resolved in that the flexibility improved but he felt resistant. I continued to work him in all 3 paces in the school 4 times per week and turned out in the field for 3 hours a day (all he can tolerate) and also had him ridden by 2 professional riders to see if they could feel something I was missing or unable to explain.....their suggestion was that my horse being a laid back slightly lazy boy was just using his neck stiffness to avoid working? I had a real breakthrough with an Equissage massage which helped for about a week but basically the whole of last year was spent having pyhsio treatments (6 treatments at a time in 3 blocks)with no real improvement. The horse was never lame, had no heat, swelling or tenderness in his legs and never apprerred to be in pain but of course he was now being classed as a performance problem. I even had him treated with ventipulmin as the vet though he may be struggling with air intake in the high pollen season.....switched to haylege and damped his feeds.....no difference. 2 competitions at Advanced medium dressage gave us respectable scores but the comment was not foreward enough and not covering enough ground........given his nature/personality no big changes to how he once was, so no particular alarm bells ringing. Just carried on,and still no real lameness /symptoms just still resnting lateral left bend and it was only when his left canter became an issue (4 time and reluctant to strike off into left canter) that I got a chiropracter in for an opinion.....felt vet was running out of ideas tho she had suggested a "bute test" to see if he was better on bute? I resisted this as felt he shouldnt be able to cover up a potential lameness ? How stupid of me ? Chiropracter felt he had a dgree of muscle spasm in his back and tight in poll and wanted to do a release under sedation (planned for end of April) Called my vet to ask her if she would attend to help with this and she said just bring him upto surgery and do a lameness work up....did it yesterday. Not unlevel trotting just very stiff and wide behind on straight line. Small concrete circle showed hind limb lameness and back on th estraight started showing very subtle left fore lameness. Head tilt to right and appearred to be holding himself....rode him in the school and vet agreed he looked better under saddle but saw his 4 time canter (worse on left rein) and his general lack of impulsion. Flexion tests were slightly positive on both hocks and front left. Nerve blocks started....upshot was lower joints of hock block made him sound(er) and less wide behind. Horse stayed overnight and X rayed next morning. All expectations were on arthritic hocks.....NO hocks were as good as any 4 year old horse and no bony changes, considered remarkable.! HOWEVER progressing on to scanning.......misery, BOTH hind suspensory ligaments were showing signs of wear tho the left significantly worse than the right, and, also altho minor, the front left suspensory affected too. Vet felt as he had responded well to nerve blocks in hocks, she injected both lower hock joints with corticosteroid as she said it would also medicate the suspensory as it was in close proximity to the hock joint. Now he is on 2 weeks box rest with in hand grazing allowed. Week 3 he is allowed 5 minutes walk in hand twice a day, then week 4, 10 minutes walk in hand twice a day then rescan. Her plan is to see what he is like in terms of improved soundness at that point and if not a real improvement to then progress to neurectomy.as mentioned above in the postings from the lady who uses the Royal Dick Vet School in Edinburgh. NO mention made of laser or any other treatment. She is obviously a firm beleiver in Neurectomy and has said that is what she firmly thinks will be his best chance. Need I say I love this horse....he is the best boy in the world,I have had him since he was 8 and we have trained each other to PSG level..he is not a good havck, cant tolerate too long in the field and is awful in traffic.......dressage is his only thing and at 15 I cant get a grip that he may never be able to do a 20 meter circle again. Just cant think of another job for him and to be honest I am in bits over this. Guilt dosnt come anywhere near what I feel for pushing him through last year when he was obviously hurting........if only he had gone lame back then, and I thought my only problem was a stiff neck and a 6 for my half pass and not an 8 ! I am so ashamed and so miserable...I have always bandaged him before working, warmed him up, cooled him down and given him best feed, hay and cortaflex.and SO fussy about the best surface for him.....any advice please would be welcome, I just am struggling to find any optimism.my vet has told me not to read books or research too much as she admits that PSD has a very pessimistic press, BUT as she has said, there are advances in treatment such as resection of the nerve that she regards highly with good results. She said my boy is a candidate for it as he responded well to the hock nerve block which also blocked the ligament pain and that this is a good indicator for success of a neurectomy. However I do know that it is STILL a big operation and surgery on any horse (altho my vet said elective surgery is much less risky statistically than emergency pre-compromised horses) is always a risk if only in the immediate recovery getting up phase! So much to be concerned about.....advice PLEASE and THANKYOU. |
| Member: Caymie |
Posted on Thursday, Apr 6, 2006 - 12:58 pm: Hi Louise,My horse is currently recovering from a right hind suspensory injury. I am curious as to what the ultrasound actually showed, what do you mean by "wear and tear?" My vet, who is a board certified lameness surgeon has told me that sometimes on the hind suspensory, you will not see much in terms of a core lesion, enlargement of the ligament etc. In his opinion, if the ultrasound does not show anything really bad, the prognosis for healing is somewhat better. Where are they saying the suspensory is injured? Just a couple of thoughts because we went on a wild goose chase before my horse was correctly diagnosed. Has the vet tried blocking only the origin of the suspensory to see if it returns the horse to soundness? That is what we finally had to do to arrive at the diagnosis because my horse has some mild arthritis in that hock as well. Even though there are not radiographic changes, it might be worth it just to make sure. His hock could still be sore. I know this fasciotomy/neurectomy is becoming quite popular for treating hind suspensories that have not responded to more conservative treatment. However, I am a firm believer in exhausting all of one's options before resorting to the surgery. And I have to admit that the idea of nerving the hind limb of a big warmblood does not really appeal to me. But I do understand that some horses that have been unresponsive to other treatments have been restored to soundness this way. My horse had three shockwave treatments and has been resting since the middle of January in his stall/run. He started walking on a water treadmill a few weeks ago. He does it five days a week. He is almost sound. He has gone from a strong grade 2 lameness down to a 1. He had no visible abnormalities on the ultrasound. Has anyone suggested trying the shockwave first? And if you have access to swimming your horse, I highly recommend it. Good luck and keep us posted. Mary |
| Member: Caymie |
Posted on Thursday, Apr 6, 2006 - 1:03 pm: Hi Louise,One other thing I forgot-my understanding is that the horse is only considered a good candidate for the neurectomy if he goes sound to a lateral plantar nerve block. Mary |
| New Member: Luley |
Posted on Thursday, Apr 6, 2006 - 6:52 pm: Hi MaryThankyou very much for your post and I am glad to hear your boy is improving...it sure seems a long road ahead. My vet and her senior colleague are convinced that the hock(s) are not responsible for the pain and the upper hock joint nerve block only showed a negligible improvement..like you, my vet advised me that a good candidate for surgery is one that shows a good response to to a lateral plantar nerve block......apparently my horse did..which brings me to the point I am at, but, I have to get through a month of box rest and rescan before an onward management plan is agreed on. I will print out your comments and mention to the vet when we speak.I am wondering why she hasnt discussed any other treatment options such as shockwave or hyDrOtherapy?? I value your comments and thankyou.......I will keep posting.my best wishes to you and your horse Louise |
| Member: Caymie |
Posted on Thursday, Apr 6, 2006 - 7:47 pm: Hi Louise,I did not understand that the lateral plantar nerve block had been done, so that is why I mentioned it. I am unsure as to why shockwave has not been presented to you as an option as well. It seems to be the gold standard for suspensory injuries. My vet is a surgeon, and he did not immediately suggest doing the neurectomy. My understanding of the fasciotomy/neurectomy is that it is usually done only after other treatment options have failed or the horse is dealing with a chronic, recurring lameness. I'm not sure how long they have been doing this procedure so I do approach it with some caution. I rehabbed my horse for a front suspensory injury as well, a couple years ago. It took almost seven months. I probably overdid it a little in terms of the extra time, but he hasn't looked back since. Rehab is a long, frustrating and sometimes dangerous process, but you have to do it right, or there is no point in doing it. I would encourage you to give your horse plenty of time first to see if he is healing, before jumping into surgery. A month just isn't that long for ligament healing. And you are right about it being a long road ahead. We do dressage as well and I sure understand your concern and hopes for your horse's future. Good luck with the decision making process, we all have to decide what we think is best for our beloved horses. Mary |
| Moderator: DrO |
Posted on Friday, Apr 7, 2006 - 7:55 am: Welcome Louise,It appears the diagnostic work and therapeutic plan are quite sensible. I would personally give Shockwave and a longer rest a chance but could not say this will markedly improve the prognosis of the outcome without surgery but I could say the more healing you have before the neurectomy the better the chance the horse will hold up. DrO |
| New Member: Luley |
Posted on Friday, Apr 7, 2006 - 10:45 am: Thankyou Dr O for your advice and comments, also too to Mary.I will see what the outcome of the rescan is in one month (assuming we get through the box rest, a very cross gelding after only 3 days!) I will post again at that time....it may well be my vet will have a better idea of the onward management of his case at that time....thankyou again for your input. Best Wishes Louise |
| Member: Caymie |
Posted on Friday, Apr 7, 2006 - 1:04 pm: Louise,The water treadmill has been a lifesaver for my horse both mentally and physically. If your time and finances allow, I highly recommend looking into it, if such a service is available in your area. Nothing like a very cross warmblood on stall rest! Good luck. Mary |
| Member: Wolfydoc |
Posted on Saturday, Apr 8, 2006 - 2:33 am: I am very confused - if we return a horse to "soundness" by doing a neurectomy, how do we know how much work the horse can endure before he totally blows the suspensory, and how does the HORSE know how much he should or should not do? Granted, horses don't necessarily limit themselves when they have a mild to moderate lameness, but isn't it possible that the suspensory can be injured even further, say a complete tear/disruption?I have only briefly scanned the literature sent to me regarding stem cell therapy but this seems to be a very promising relatively new treatment option, although it is best for injuries diagnosed in the more acute stages. My vet called VetStem, the company who does the collection of the stem cells from adipose tissue submitted by the horse's local vet, to ask what kind of results they are getting in chronic cases. I don't know what kind of answer he got, but I plan on calling VetStem back on Monday to find out for myself. My vet, a board certified surgeon, does the procedure and claims he is getting "really good" results in more acute cases, especially those with core lesions. I have not posted anything about the articles I received because I wanted to get these last pieces of info, but I felt I better say something at this juncture. Very briefly, Vet Stem claims they are getting a 78% return to previous function in non-racing horses with suspensory desmitis. Note that the healing times are not shortened per se, you just get better quality healing histologically. I need to ask several questions about their data, including the acute v. chronic, front v. hind, location of lesion in the ligament, type of lesion, age of patients, types of work returned to, concurrent therapies/rehab, recurrence rates, etc., etc. (DrO feel free to add any additional questions I might ask) but an independent researcher named Linda A. Dahlgren, DVM, PhD states in the 2005 AAEP Proceedings that initial indications are stem-cell treated horses are successfully returning to competition. It is an "area with tremendous potential that requires further rigorous investigation." By the way, her presentation "Review of Treatment Options for Equine Tendon and Ligament Injuries: What's New and How Do They Work" had no mention about neurectomy. Cindy |
| Member: Caymie |
Posted on Saturday, Apr 8, 2006 - 8:30 am: Hi Cindy,That is precisely my concern regarding the neurectomy as well. If that ligament is already weakened/prone to reinjury, I sure don't want my horse to not be able to feel it. And I don't really understand even if the injury is chronic, how that is going to prevent such a scenario. The only way this makes sense to me is if the pain is coming more from this compartmental synDrOme. But even if there is no major core lesion there is still obviously pain there and if you remove the pain, I would think the horse would be as risk for overdoing it and possibly incurring a very bad injury. That is why I am trying everything possible to see if my horse will heal without the surgery. I did ask my vet about the stem cell, but lost interest in that too when he told me the horse would have to go under general anesthesia to have the procedure done. Is that your understanding as well? Since my horse's ultrasound didn't show any major lesion or enlargement, he felt that the stem cell treatment would probably not be necessary. However, I would be interested in learning more about it just in case. Mary |
| Moderator: DrO |
Posted on Saturday, Apr 8, 2006 - 10:47 am: I went and reviewed the AAEP Proceedings concerning Vet Stem's therapeutic option for soft tissue injuries. Though promising the study cited and it still is a long way from being considered a therapy supported by scientific investigation:
The neurectomy concerns expressed by Cynthia and Mary above are right on. The surgery is best reserved for those who have no or minimal lesions visible on US that have not responded to more conventional therapy. DrO |
| Member: Caymie |
Posted on Saturday, Apr 8, 2006 - 2:52 pm: Hi Dr. O.,Thanks for your input on the neurectomy surgery. That is why I am going after Caymann's injury with everything I can including the swimming and the shock wave. I DO NOT want to have to do the surgery. Although I think that my vet feels that he would be a good candidate since he has minimal changes on the ultrasound. But given that, I also believe that increases his potential for healing if just given the proper time and rehab. My vet agrees and we will look at him again next week to see if there is further improvement. I guess if he does not come sound with the current management, then one might assume he could be a candidate for the neurectomy as the pain is most likely due to the compartmental synDrOme. The other thing that makes me nervous is the newness of this procedure. I would be very interested in knowing what the long term outcome for these horses has been. We'll keep you posted- Mary |
| Member: Wolfydoc |
Posted on Saturday, Apr 8, 2006 - 10:20 pm: I guess I'm not clear on how a horse can have a significant lameness attributable to the suspensory with little to no abnormalities on ultrasound. I got the impression from the article here that the ultrasound was the guiding factor for monitoring healing. How does a horse not have significant ultrasound changes but pain originating from the suspensory?? I remember my vet telling a client that if a horse has acute onset pain in the suspensory, but no significant changes on ultrasound, he doesn't get too worried and these horses will go sound with 2 to 3 weeks rest usually. This certainly doesn't jive with Mary's horse's history.And Mary, most horses don't need general anesthesia - most are done standing, sedated, from what I've read and been told. DrO can affirm or deny this. There are a few with hard to get at lesions in the hind suspensory that would need general. My friend's horse just had the procedure done, and his lesion was in the proximal (high) suspensory. I would think this is about the most difficult part to get at, but obviously I'm wrong. But it does make sense Mary, if there is no definitive lesion, then how would you know where to inject, and why bother if the structural integrity is not substantially altered based on ultrasound. My understanding is that the stem cell therapy apparently can help with the overall quality of the tendon repair. I agree with all your comments DrO about Linda's study she cited. I was more interested in - although more leary about since it is biased - Vet Stem's clinical results. If the overall prognosis for healing of proximal suspensory injuries is already known to be poor, then it sure raises my eyebrows when someone claims a 78% return to previous function, whatever that means. I certainly don't take a biased source's word for anything! I also really respect my board certified vet - he also is very skeptical about new treatments, obviously understands the difference between scientifically supported v. unsupported claims, but would not BS anyone about it. He seems very optimistic about it in his own hands, but primarily for the acute cases diagnosed early, with core lesions. |
| Member: Caymie |
Posted on Saturday, Apr 8, 2006 - 11:09 pm: Hi Cynthia,My vet told me that there are a small minority of horses with origin of suspensory lameness in the hind end that do not have any significant ultrasound abnormalities. I am certainly glad that there was nothing really bad on the ultrasound, but it does complicate the monitoring of the healing process. All we really have to go on is his continued improvement with shockwave, rest and controlled exercise. We also have the added complication of the mild concurrent arthritis in that hock. However, I think we believe that we have addressed that part of the equation sufficiently with the hock injection. And I wouldn't expect him to return to soundness with a lateral plantar nerve block, if we were just dealing with lower hock joint pain. However, I suppose one theory could be that if there is nothing really bad on the ultrasound, then the pain could be caused by the compartment synDrOme, especially if the injury is chronic. Perhaps Dr. O could comment on this. I think too that sometimes lesions coorlate poorly with suspensory lameness, but I would again defer to Dr. O on that as well. I will ask my vet more about why they put horses under general anesthesia for the stem cell therapy. It is good to know that that is not necessary in all cases. Oh how I wish that he would have come sound in two to three weeks! If he is sound this next week when the vet rechecks him, it will have been just a little over three months since he has been resting, and just six weeks after his final shockwave treatment and nine weeks since the initial diagnosis. Mary |
| Moderator: DrO |
Posted on Sunday, Apr 9, 2006 - 10:02 am: I think this discussion is confusing because not everybody is talking about the same thing at the same time. There are many forms of suspensory desmitis and even whether it is in the front or hind makes a difference.In general acute traumatic proximal suspensory without remarkable tears has a fair to good prognosis whether in the front or behind. I personally think the reason why statistically hindlimbs have a worse problem is that we see some form of a progressive degenerative disease in these structures. Perhaps a better name for what is being treated with neurectomy would be high palmer/plantar pain synDrOme, since there are no obvious lesions the source of the pain remains unknown doesn't it? I know little of the surgery but I do what I think of as a simpler PD neurectomies laying down. Concerning the stem cells, best would be US guided placement of the stem cells and if this could be done in the standing animal great. Fronts will be much easier than backs and some animals may just not be cooperative enough to do a hind limb standing. While it is true that suspensory lameness varies quite a bit from the US lesions, the prognosis usually does not again with the exception of degenerative conditions which can have mild lesions that worsen over time even with pasture rest. If the pain refers to the suspensory but the US not bad, I expect, with proper rest, for that horse to return to soundness. DrO |
| Member: Caymie |
Posted on Sunday, Apr 9, 2006 - 10:18 am: Hi Dr. O.,Good job addressing all of our discussions! I think that pretty much sums up my situation anyway, a high suspensory lameness with basically a clean ultrasound. But based on my own personal experience and my vet's advice as well, that does not necessarily mean it is only going to take a few weeks to resolve. That makes perfect sense to me since horses with obvious core lesions can take up to eight or nine months to heal. I just feel very fortunate that we have caught this in time (hooves crossed) before it did progress to a scary ultrasound/poorer prognosis. I will ask my vet just out of curiosity, why they prefer to do the stem cell procedure under general anesthesia. I didn't pursue it any further as I lost interest after learning that it required the general anesthesia, and his ultrasound did not seem to indicate that would be necessary. Mary |
| Member: Caymie |
Posted on Friday, Apr 28, 2006 - 7:29 pm: Hi Dr. O and Cynthia,(I have already emailed Fran privately, so she has been updated). Just wanted to let you know how our situation has resolved. Caymann had been steadily improving with the shockwave and rest. Since his healing had sort of reached a plateau, I started to become suspicious that the remaining mild lameness was due to his hock, not his suspensory. I started increasing his work and lo and behold, he worked out of the lameness instead of worsening. I was even able to get him to put his tongue back into his mouth after a good warmup. I asked the vet if we could inject his hock, we did, and he is now sound! I really believe that something very strange happened to him with the initial hock injection that he had a terrible reaction to. Prior to that injection, he was rideable, he just had the mild arthritis in his hock. Right after the injection, he was much much lamer, mostly in the soft arena. And he worsened with exercise, not improved. That would explain why he improved so much with the block to the origin of the suspensory but there were no ultrasound changes. Certainly there was pain there, but not any horrible lesion. So, I suspect that the suspensory healed up several weeks ago, which was when he sort of stalled out in terms of improvement. And Cynthia, he put his tongue back into his mouth instantly after the hock injection. He is very sensitive to pain, as we now know from all of our diagnostics that he has mild arthritis. The level of drama doesn't quite match the level of lameness. But at least he lets me know. So, now I even have the tongue-o-meter to tell me when he is hurting. How convenient. My vet has done an incredible job with a very frustrating case. Certainly he was able to catch the suspensory lameness before it became an even bigger problem. I am looking forward to riding my horse this weekend. Dr. O., is it possible that the suspensory could have been damaged if the needle went somewhere other than where is was supposed to? Or could the medication have caused that much soft tissue damage? Mary Mary |
| Moderator: DrO |
Posted on Saturday, Apr 29, 2006 - 9:22 am: Most of these injections Mary are not irritating but unusual individual reactions are possible. And I almost forgot, congratulations on your sound horse!DrO |
| Member: Caymie |
Posted on Saturday, Apr 29, 2006 - 9:31 am: Thanks Dr. O! There are days when even I can't get my head around all that has happened since that initial hock injection. But the important thing is that I have my horse back. Thanks for all your advice and for such a wonderful resource.Mary |
| Member: Wolfydoc |
Posted on Tuesday, May 2, 2006 - 2:22 am: Mary,My best friend's horse had a severe reaction to a local anesthetic injection in the high suspensory performed during a diagnostic workup - the entire rear cannon area swelled up and what was a mild lameness became severe for quite a while. Several rounds of different antibiotics did not seem to affect the course, and cultures of aspirates came back negative, so it did not seem to be an infection, but who knows. In my humble opinion, there is no such thing as a drug that never has any side effects, and a local anesthetic is no different. Cindy |
| Member: Caymie |
Posted on Tuesday, May 2, 2006 - 6:15 am: Hi Cynthia,That is interesting that your friend's horse had a similar experience. Now our situation doesn't seem quite as odd! I am almost certain that the very bad reaction Caymann had to his initial hock injection is what caused the lameness in the origin of the suspensory. He went from a lameness that he mostly worked out of (the mild hock arthritis) one day, to looking almost crippled in the soft arena following the injection. Because it took us awhile to figure out what was going on, he wasn't resting, so it didn't heal. I'm not sure if the needle and/or medications went somewhere they weren't supposed to, or if he just had a reaction to the medication itself. What a mess. Anyway, the important thing is that he is OK and the vet caught the suspensory lameness before it became any worse. Mary |
| New Member: ridewell |
Posted on Saturday, Sep 6, 2008 - 9:43 pm: Hi Mary and CynthiaI have read your writing with interest, especially as my beloved horse is about to undergo a neurectomy/faciotomy for PSD. whats more worrying is that he too went severely lame after a hock imjection. He was not at all lame but stiff on right rein, and he didnt move straight,so my vet suggested a shot of something that enables the joint. He was sound and well 3 weeks after, and then suddenly went very lame, and then began our diagnosis of PSD. did he have it before? possibly, but did the injection make it worse, or did it nick the suspensory and cause inflammation, we will never know. what i do know is that im nealry out of insurance money and my darling horse has no choices but an op now. Hes almost five months lame, no obvoius lesions, but only slight improvement from 4/5 tenths lame to 3/4 tenths in 5 months, after 4 weeks coral, and shockwave and adequan injections. Im terrified of op, but he is too lame to ride, and he is too sad as a lawnmower, if he could become well enough to hack i could find him a nice sharer, if he came back to dressage even low level, it would be a miracle. Op will be scheduled in next 10 days or so. I am aware of all the risks, and have done everything to avoid this, but I feel he needs a chance to get really well ;-) Hope i will feel i did right thing even if it goes horribly wrong. Thanks for listening. Lisa |
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