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  Discussion on Aggressive strategy for rehabbing OTTB
Author Message
New Member:
lghocelo

Posted on Monday, Jan 14, 2008 - 4:59 pm:

I am currently evaluating youngsters (3-4 YO) to retrain off the track -- as I have done many times. However, I wondered, Dr. O, if you have any advice on an optimal strategy for halting nascent degenerative joint disease and setting the stage for maximum useful life for my new guy? I know I can't undo what's done, but might aggressive interventions stop damage from progressing?

I'll get a PPE, but that can only tell me the horse's state at the moment (probably won't get films--some OTTBs are sound with ugly radiographs while others X-ray clean and are lame soon after). It's often impossible to know if a trainer used (damaging) steroids indiscriminately, and there's almost always some joint wear/damage from over-training as babies.

Do you think there's any value in "proactive" interventions in a sound horse with suspect history--in essence assuming that there IS subclinical DJD and treating it? My vet loves IM Adequan, and I'm financially able to use it on the "can't hurt, might help" theory (my old warmblood mare seems to do well with a course of it every fall). I give high-dose oral PSGAGs/HA (Cosequin, Recovery EQ and CortaFLX) on the same principle. But what about a more aggressive strategy? Even IA triamcinolone acetate -- since it's had some reported broad benefit -- or IA Adequan or Legend?

I'm about 7 for 10 keeping OTTBs sound long-term (enough for 3' hunters and first/second level dressage). If finances are no object, might there be a benefit to treating key joints upon arrival--with appropriate rehab and physical conditioning--to get the horse stabilized and on the road to long-term soundness?
Moderator:
DrO

Posted on Tuesday, Jan 15, 2008 - 7:13 am:

Welcome Laura,
Hmmm the first thing that comes to mind is that in some large studies of animals that go through prepurchase exams overall 70% of the horses that enter any type training actually go on to their intended use. Note that this number holds whether or not they passed the prepurchase exam in one study. So, considering you are starting with a "heavily used" animal your numbers may be about the best you are going to achieve.

Concerning your direct question, there is little research to clearly answer your question so we are just flying by the seat of our pants and a lot depends on what you mean by "proactive". As you note there are several different scenarios that should be approached differently:

In the first case where there is no evidence of current or future problems, I believe the only "proactive treatment" that makes sense when you balance cost and known benefit is the oral nutraceuticals recommended in the article.

In the second case where there is no pain but you have a "defect" that portends possible future problems I would consider a single injection of IA Adequan on discovery of the defect. Some very critical arthropods feel a one time IA dose lowers the incidence of arthritis following arthroscopic invasion of the joint. Then I would manage the defect as though it were a disease process itself with the treatment tailored to the problem, continuously monitor it for change, adjust therapy based on change, etc... For more on all this see the article on arthritis and be sure to follow the links to articles on specific disease and medications so you can get the details.
DrO
New Member:
lghocelo

Posted on Tuesday, Jan 15, 2008 - 9:27 am:

Thank you, Dr. O--very helpful. I've read everything on this site (and everywhere else I can find), but there are so few really definitive answers.

I do think I've done well with the OTTBs, but the ones that don't stay sound are inevitably the ones I really fall for--and it's heartbreaking in any case! Fortunately with all the rescue networks i've been able to find pleasure-horse homes for them. I guess what I really want are assurances and treatments that aren't out there yet... but failing that, I want to be sure that I am doing the best I can for my horses with what IS out there.

Thank you again!
Laura
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