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  Discussion on Horse had intra-articular injection, now PU/PD
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New Member:
lindas

Posted on Wednesday, Mar 12, 2008 - 11:07 pm:

Hi Dr. O,
My 6 year old 1000 lb Paint Gelding has been stall rested with daily increasing walk/trot "rehab" rides for 3 months, for mild suspensory desmitis and articular pain in the fetlock of the left front leg. The conservative approach has not worked (he got better then relapsed) so on to Plan B, shock wave therapy on the ligament and an intra-articular fetlock injection. He is being treated by a board certified equine surgeon. He is otherwise very healthy, and is in good flesh, eating normally, etc. One week ago he had an intra-articular injection of Hyaluronic Acid plus Triamcinalone, along with his first shock wave treatment. The next day he began drinking about twice as much water as usual and is urinating a ton! Normally he only drinks about 5-8 gallons a day and has 2 urine spots in the am and pm. Now I am going through a ton of bedding and he is drinking 10-15 gallons a day. Today after his second shock wave treatment he urinated three times in 2 hours. These are normal amounts of urine each time. The total amount of water and urine does seem to have tapered off by about 20% in the past 24 hours, but it is still excessive.
The doctor who is treating him is out of town all week and cannot be reached. Today I asked his associate (who did today's shock wave) if there is any association between intra-articular injection of triamcinalone and PU/PD. She is a new graduate, and said "not usually", and offered up a possible explanation of boredom. I would think if it were boredom he would have done it before this week, as he has been stalled for 3+ months.
The only other drugs he is on are low doses of acepromazine (1 cc IM once a day, ordered by the specialist), so I can do his rehab walk/trot riding. (I tried it without the ace, and promptly landed butt first in a briar patch!) He is just too crazy after being cooped up for so long! He did have 2 cc ace last week for the trailer ride to the specialist, and when we got there they sedated him (don't remember the drug) for the intra-articular injection as he was still not quiet enough for them. He had another 2 cc today for the trailer ride, but did not need any further sedation for the shock wave treatment.
So my question is: do you think it could be the triamcinalone in the joint injection causing PU/PD? Or could it be the drugs we have been using? Do you think I should go ahead and pull a metabolic profile on him with UA or should I wait and see if the symptoms subside when the triamcinalone wears off? ( in dogs it takes about 2 weeks, don't know about horses)
Thanks!
Member:
scooter

Posted on Thursday, Mar 13, 2008 - 7:01 am:

Hi Linda Dr.O. can answer your questions, but when my horses are tranqed they pee ALOT afterwards. One horse I was familiar with on stall rest was given ace to keep him quiet and his stall was always flooded...I don't know if he drank more or not he had an auto waterer. Good Luck
Moderator:
DrO

Posted on Thursday, Mar 13, 2008 - 7:47 am:

Hello DrS,
I have to agree with your veterinarian's associate, usually the amount of corticosteroid injected IA does not seem to enough to induce this. I would be interested in the dose he received. Considering it's acute onset associated with the use of a steroid and that it seems to be improving, I think as long as PE remain normal I would take a wait and see while making sure plenty of water and a salt mineral block available.

Following 90 days rest if the horse remained painful I would add 30 more days, I have had several cases that took 4 months to heal. Be careful with the shockwave do to its anesthetic effects I believe it leads some to put horses back to work that are not ready for it. For putting horses back in work I like 2 - 4 cc in the feed several hours before the walk. And considering the consequences of under sedation, I start at the high dose and work down.

Diane, the alpha-2 sedatives (xylazine and detomidine) do have a strong but short lived diuretic effect but ace does not usually cause a noticeable change in drinking and urination.
DrO
Member:
frances

Posted on Thursday, Mar 13, 2008 - 9:49 am:

Hi Linda. For what it's worth, when my horse once had two joints injected with a corticosteroid (I don't remember which) + hyaluronic acid, she drenched her stall with urine for a week. The vet seemed surprised when I mentioned it but after calculating quantities given, agreed that it could be a result of the steroid. I felt sure it was, as the same thing had happened once before.
New Member:
lindas

Posted on Thursday, Mar 13, 2008 - 10:57 pm:

I don't know the exact dose of the steroid used. I will ask next week when we take him back for the final shock wave. It has been years since I dealt with equine medicine, so this is a bit out of my field. He actually seemed better today. I did not have to take out as much bedding out of his stall tonight, and there was actually a little water left in his bucket. Maybe he is just ultra sensitive to the triamcinalone...or to the sedative that they gave him one week ago.
Dr. O...are you talking about using 2-4 cc of the "injectable" form of acepromazine in the feed prior to riding? Is it easily accepted? How long after feeding should I wait before riding? I know there used to be ace granules for horses. Don't know if that is still available, but the injectable form is easy to get of course. I know that Reno would appreciate not having to get a shot 30 minutes before every riding session. His wonderful, calm, bomb proof disposition is being sorely tested with all this stall rest! Believe it or not, according friends that have known him since he was little, I am the first person that he actually bucked off! (I'm sure that speaks volumes about my rusty riding skills! I have only been back in the saddle for 1 year after a 20 year "break") As for the shock wave therapy, there is a 6 week rehabilitation program that I have to follow to the letter before his recheck and repeat ultrasound. Poor horse...I'll probably shake in my boots every time I to turn him out in pasture or work him hard for years after all this!
As for the urinary problem, I'm going to take a wait and see approach like you suggested.
Thanks.
Moderator:
DrO

Posted on Friday, Mar 14, 2008 - 5:27 pm:

Hello DrS,
The extra sensitivity part may be right, yours and LL's posts are not the first on this board that have commented on such a reaction with IA steroid. Much larger (pharmacologically active wise) doses of IV Dex often does not cause such a noticeable reaction.

Treatments and Medications for Horses » Sedatives & Anesthetics » Acepromazine for answers to your questions and the discussion section has others experiences with using it orally.
DrO}
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