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Discussion on Suspensory issues...need advice
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New Member:
vinni
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Posted on Monday, Jan 19, 2009 - 6:14 pm:
18 year old Tennessee Walker I've owned for 16 1/2 years. Ex show horse (Plantation Walker...not padded). Barefoot. Trail ridden past 6 years. First signs of Right Hind lameness beginning November 2007. Noticeable lameness after laying down at first. Seemed ok under saddle for a couple months, sometimes seemed stiff/off for a while then warmed out of it. Lameness exam done in March 2008. Vet blocked her which made her (less than 100% sound. I forget specifics). The suspicion was Annular ligament injury with possible Suspensory ligament involvement as well. US revealed constricted Annular ligaments in both hind legs. Pasterns/fetlocks (not sure where you inject) injected with steroids and one month of no riding but she was turned out daily. She seemed fine. I trail rode up to once weekly, mostly walking, and she seemed fine. Two weeks ago a 6 year old rode her for 45 minutes in a small paddock (1/2 acre) walked, flat walked, and cantered. She seemed fine the next day and was ridden 2 days later and seemed sound. During this outing she was lightly ridden but took a few laps around a riding ring with deep footing. The next day severely lame. Trouble getting up from laying down. Same Right hind leg lameness. I gave her bute. Surpass on both hind legs and bandaged her legs. Did this for 3 days then she seemed sound so I stopped the bute. Lameness returned. Vet called. Planned to just reinject the pastern/fetlock but upon exam vet didn't like what she saw and reultrasounded her today. She says her Suspensory ligaments in her hind limbs look like swiss cheese... other than that I don't know actual measurements or where exactly in these ligaments she's having issues. Vet recommended: (1)best way of treating: Stem cells, adequan, surpass, bute, bandages, and stall confinement. (2) second best: everything but the stem cells. What would you do? Can I really expect these stem cells to fix her or are they like a bandaid and I should expect to do this how often? Can I expect a complete recovery (doubtful)? I want her to live as long and comfortably as possible. I can live without riding her again if this would keep her healthy longer. The whole stall confinement for months bothers me a great deal. How necessary is this? I can't imagine doing this to her. What other information do I need to know to give you a better picture of what's going on so you can give me the best advice you can?
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Moderator:
DrO
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Posted on Tuesday, Jan 20, 2009 - 9:01 am:
Welcome Amanda,
What we need to give more specific advice and prognosis is the exact findings on the ultrasound exam and the diagnosis of the examiner. This description should include the location within the suspensory of the lesions, the number and size of the lesions, and their nature. I see many horses with photos like those posted who do not have lameness issues so they alone do not help.
DrO
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New Member:
vinni
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Posted on Tuesday, Jan 20, 2009 - 4:30 pm:
Dr. O,
Thank you for telling me what questions to ask. Here's what I was told. The diagnosis is Bilateral Branch Desmitis. When I asked about DSLD she said that this was likely. I thought these were two different diagnosis but I do understand that it's difficult to get a true diagnosis of DSLD. The vet said location of the lesions are in both branches of the suspensory's of both hind limbs. When asked the number and size of the lesions she told me that she doesn't have one big lesion just multiple areas of strain throughout from the attachment all the way down to the (I think she said check ligament) or basically I believe she was telling me the whole ligament in general had these areas of strain. I asked her some questions about Vet-Stem Vs A-Cell therapy and we decided that the Vet Stem would be the better choice if I go that route. She said as far as costs it would be similar because of the amount of damage to the suspensory we would have to order two syringes of A-cell to fill in all the damaged areas so we may as well go with the better treatment. I'm not sold on this Stem Cell treatment. I don't want to fall for a gimick...I will spend the money if I can convince myself that this is the best thing for her...but of course as with many people money doesn't grow on trees around my house. She is currently on 2 grams of bute SID X 1 week, Stall rest, Surpass, and bandages. I've ordered the adequan and will start that on Thursday. She was eating T & A but I recently switched her to just Timothy to see if that would help her lose weight. I give her an unlimited amount. I feed her Equine Senior but I've gotten her down to about 0.8 pounds a day (enough to allow me to mix in her Cosequin ASU) I've bumped the Cosequin up to 2 scoops daily to see if that would help as well.
Under FAQ The website for Vet Stem said:
Can regenerative stem cells cure degenerative suspensory ligament desmitis (DSLD)?
Vet-Stem does not recommend treating degenerative suspensory ligament desmitis (DSLD) with regenerative stem cell therapy due to its diffuse and genetic nature.
So that's a bit confusing to me.
What's your take on all of this?
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Member:
lindas
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Posted on Tuesday, Jan 20, 2009 - 10:03 pm:
I am not an equine vet, but am going through the suspensory ligament injury mess with my own horse, on the front leg. It is a long road with months of daily rehabilitative walking and riding. In my case my Equine specialist did not feel that Vet Stem would work, because the lesion was diffuse, without a large enough core injury to inject the cells into. We ended up doing shock wave treatment after my horse failed to adequately respond to conservative therapy. I was amazed at how fast he healed after the shock wave. My understanding is that stem cells are very useful in certain circumstances and carefully chosen cases. I'm sure Dr. O. can give you more information about that in horses. While recently going through the small animal Vet Stem training, I learned that you must have a space to put the cells in. If the lesions are diffuse and spread out over a large area it is difficult to find the space to inject the cells.
I'll bet the trip around the arena in soft sand is what aggravated this injury. My equine vet insists that suspensory rehabilitation needs to be done on a firm surface, straight line, starting at a walk and gradually over many weeks increasing the amount of trotting. Don't know what gait you would use with a TWH. Cantering is done in gradually increasing times only after many months of rehab., and still in a straight line on a firm surface.
Good luck with your horse.
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Moderator:
DrO
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Posted on Wednesday, Jan 21, 2009 - 10:02 am:
Hello Amanda,
To try and make your veterinarian's description clearer: "desmitis" is not so much a diagnosis as a pathological description meaning a inflamed ligament. A good diagnosis also describes the cause and extent. For more on DSLD including cause, diagnosis, and treatment see Diseases of Horses » Lameness » Diseases of the Lower Limb » Degenerative Suspensory Ligament Desmitis (DSLD).
I cannot explain why Vet-Stem advertises that way but agree with their conclusion that it is not a promising treatment for DSLD. Partially for the reasons DrS states above but also because of the progressive degenerative nature of the disease.
DrO
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New Member:
vinni
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Posted on Wednesday, Jan 21, 2009 - 10:57 am:
Dr.O,
I just reread the info on DSLD. With the information I gave you, would you lean towards a Dx of DSLD or is it completely up in the air still? Should I get her front legs US as well? Would this help with a Dx? Or does an actual Dx even matter at this point if the Vet Stem is not recommended in her situation? Do you believe at this point I should follow the second treatment plan given by my vet...Adequan series, Bute for one week. Surpass and bandaging for (I'm not sure how long...one month?). Stall confinement for one month. Then turn out and no riding for six months. DO you believe that stall confinement is necessary? Vinni isn't a horse that does a whole lot when turned out though she occasionally will feel frisky/hungry and canter on her way into the barn for feeding. I honestly hate to keep her locked in her stall. I usually give her and the other two horses access to a 2 acre pasture. I also have a 1/4 acre dirt paddock I could turn her out in. I'm a little annoyed my vet would recommend the Vet Stem Tx for her if it clearly isn't indicated in Vinni's situation. If the Vet Stem isn't recommended am I to assume the A-Cell wouldn't be a good option either?
Dr. O if I'm correct, you had a TWH with this condition. Please give me your best advice and any additional information that you think would help me.
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Member:
dres
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Posted on Wednesday, Jan 21, 2009 - 11:13 am:
What I can add is that any soft tissue injury to the legs take a whole lot of time to heal plus more again ! Time off is your best friend.. Slow hand walk conditioning is your friend in the beginning.. Keeping a horse quiet / from further hurting themselves is primary goal..
All of us who have had to rehab a horse back from a tendon injury can feel you pain and anxiety.. It is not a easy job , one that takes patience ..
On the first day God created horses, on the second day he painted them with spots..
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New Member:
vinni
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Posted on Wednesday, Jan 21, 2009 - 2:03 pm:
I'm am convinced this is a disease/affliction that can NOT be healed so to lock her in her stall for an excessive amount of time seems unhelpful and could potentially cause other side effects from lack of exercise. I believe the rest of her life is going to involve maintaining this life long disease that she has, so locking her up seems useless to me. I'm guessing the recent onset of limping was caused by a larger strain that was put on her already failing suspensory ligaments. Perhaps putting her on stall rest will help her most recent (I'll call it a flare up instead of injury)flare up but I don't think it's going to cure her underlying problem.
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Member:
stevens
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Posted on Wednesday, Jan 21, 2009 - 2:59 pm:
Ann is right; time is what is needed. My horse had a 50% tear in his superficial flexor tendon. We did stem cell, tenoscopy and rest. He was recovering well and then relapsed. That was March of 2008. Since I had followed the recommended protocol and he relapsed, this time around I decided to take it much much slower. We did walking under saddle, on firm ground, in straight lines, from March of 2008 until right after Christmas 2008 (yes, 9 months). He is now trotting sound. We do 5 minutes a day of trotting, on straight lines, on firm ground. I'm not going to increase it for at least another month.
For his mental health and my physical safety (long story ending with 3 broken ribs) I do turn him out in a 30 foot diameter round pen maybe once a week, started that after 6 months of just hand walking and walking under saddle. He usually rolls several times and then jumps around for maybe 2 minutes and then settles down. I am still going to give him every chance to recover as much as he can.
I don't know why you are convinced that this cannot be healed if you don't give it a chance. If you need to turn her out, I certainly would do everything possible to limit the size of the enclosure to something considerably smaller than 1/4 acre.
Stall rest for 1 month is a piece of cake.
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New Member:
vinni
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Posted on Wednesday, Jan 21, 2009 - 3:44 pm:
If Vinni had a Tear in one of her Ligaments then I would certainly follow the strict stall rest and give it every possible chance to heal. Vinni has strain throughout both branches of both hind suspensory's so I think my horse and Chris' horse have two different problems going on. Am I right DrO? Vinni doesn't have one lesion...her whole suspensory ligaments on both hind legs are inflamed and filled with areas of strain from what I understand. My guess is this is something that's been cooking for years. Looking back Vinni has seemed to always have trouble with wind puffs and stocking up behind. This probably has been going on for years. Last year when this occurred for what I call the first time, I had just brought her home to my new barn and back yard after she had spent 2 years being partially leased to another person. I had a child and didn't have time enough to enjoy and ride her and I have no idea if the leasee would have recognized this issue with the easy trail riding she was doing. The first time I noticed the limp it was because I happened to be there when she got up after laying down for sleep. Even before this she was partially leased to a different person for 3 years and I didn't ride much and the lessee barely rode enough to make Vinni sweat. So prior to last year when I brought her home, I haven't really ridden Vinni for any length of time for 5 years, that's why I think this has likely been going on for some time without anyone noticing enough to bring it to my attention.
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Member:
stevens
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Posted on Wednesday, Jan 21, 2009 - 3:52 pm:
Amanda,
You are correct that your horse and mine have very different issues; I believe yours is much less severe than mine. Not exactly the type of contest I'm happy about winning.
Only you know what is the right answer for you. I am not judging you, just providing some perspective.
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Member:
scooter
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Posted on Wednesday, Jan 21, 2009 - 7:46 pm:
Amanda I'm not quite sure what you are saying is the diagnosis? Is it DSLD? I have a mare that has DrOpping fetlocks and they used to swell remarkably, she was very uncomfortable with it, switching her weight quite often in the rear. I did have the vet look ate her a few times and I really never got a diagnosis (she was around 27 at the time) Lock up made her worse. Bute didn't help.
What helped her was weight loss, I see your mare is a little "plump" and you said she was on a diet, but I think a horse with any lameness issues should be on the light side...I struggle with this always!
I don't know why but legend shots (IV) seemed to help her also.
IF it is DSLD you think she has there may be some type of shoeing that will make her more comfortable. You may just have to experiment (with in reason) to see what makes her comfortable. Every horse is different.
I think Ann tried the patten shoe on one of her horses that had DSLD? But don't remember the outcome. Ann????
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Member:
vinni
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Posted on Wednesday, Jan 21, 2009 - 9:58 pm:
Diane..I chuckle when you say plump because you are very correct. I've been trying to get the weight off of her for a while by decreasing her Equine Senior feed down to less than a pound per day. Today I just started switching her over to Nutrena Litebalance to see if that helps and I also switched her over to Timothy hay instead of T&A to see if that helps. The problem is My vet was a little vague I guess. She said Vinni has Bilateral Suspensory Ligament Desmitis in both hind legs. I asked her if she thought it was Degenerative and she said yes... She never actually named it DSLD, but what I've read about DSLD it is hard to get an absolute diagnosis. It's a little confusing to me. She hasn't seemed lame to me yesterday and today so either the bute is helping or she's just better enough that I'm not seeing the limp as she walks around her small stall. I don't know anything about Legend. I'll have to read up on it.
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Member:
rtrotter
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Posted on Wednesday, Jan 21, 2009 - 10:08 pm:
Hi Amanda,
Do you have any pictures of Vinni as a younger horse? The reason I am asking is that from the pictures posted here it appears that her conformation behind would predispose her to having suspensory and rundown problems. It may just be that she is very uncomfortable and that the way she is standing relieves some of the pain.
I come from a racehorse background, so my take on this may be quite different than others and even Dr O. My perspective is even different than many racehorse trainers, but as they say to each his/her own. I have dealt with horses that have had very serious injuries including bows, suspensories, and broken bones. The only ones I kept stalled were the broken bones. Everything else was turned out 24/7, their injuries worked on daily and some were lightly worked depending on the severity of their injuries. I have never injected any soft tissue problem with cortisone, to me that is only a temporary fix and will most likely compound the problem at a later date ( which is what I think happened to your horse). I instead hose ( every day), poultice ( when there is heat), paint ( with s-b solution, used to be called shin-ban) and sweat with Victory Lane Liniment. Once the legs are cooled out, I paint and sweat in three day intervals, 3 days paint and 3 days sweat. The paint lets you control the healing inflammation and the sweat keeps the legs from getting skinsore from the paint. It works.
I do not use bute except in rare cases because I think it masks a multitude of problems ( and creates some others) and makes horses feel better than they are, which in turn makes them do things they shouldn't. As far as the Surpass goes, I think it is expensive to use for the problem you are dealing with and I am not sure if this is a longterm cost effective solution for you.
I would also be looking at her feet, the next time she gets trimmed find out what her angles are. Horses with suspensory problems do not do well with low angles and long toes ( although her feet do not look bad in the pictures)
Ok that's it for my racehorse perspective ( even though I know she is not a racehorse). I would want to try and heal her at least to the point where she is comfortable.
I would also put her on OCD Pellets. I have posted before about this supplement And I have had some really good results with it. My horses have been on it long term and they seem to be able to take the rigors of racing much better and have less soft tissue and joint problems and although I have no scientific proof, I think it may even affect the elasticity of other cells in a horses body ( Lungs in particular). I have no horses that bleed.
Sorry for rambling so long, but I know you want to help your horse and I am just trying to give you another alternative.
I wish you and Vinni the best
Rachelle
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Member:
vinni
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Posted on Wednesday, Jan 21, 2009 - 11:40 pm:
Rachelle,
Thank you for taking the time to give me all the remedies you use.
I believe Vinni is standing like this because she is uncomfortable in this picture. I do know that her conformation isn't great but it was good enough to allow her to stride deep behind and shake her head enough to win lots of blues in the Florida Walking and Racking horse association shows. I would guess that lots of TWH's end up with problems such as Vinni because what they want in the show ring is a deep back end. I tried to do a search of TWH's and DSLD but not too much came up....maybe it's kept quiet so as not to affect our breed like the Peruvian Pasos...I wouldn't be surprised, seeing that it is still common to find trainers still soaring their horses. Many TWH people are not very honest I've discovered through the years.
I do not feel any heat in her legs. I'm not sure if I would notice heat or not I've never felt it before. I haven't had a horse with anything like this in the past so it's all very new to me. She's been my only horse for most of my life.
I like your way of treating injury's. I understand what you mean about using Bute or any pain killer. I have a whole box full or Surpass that I bought at cost (through the small animal hospital I work at) last year when I first noticed her problem, So I don't hesitate to use it now in hopes it helps. I'm doing the Adequan as well because even if it doesn't help this problem I've always felt she has arthritis (always has been stiff behind when I lift her legs to clean her feet...makes me go hmmmmm).
The farrier came out today and I explained Vinni's problem to him. He doesn't feel that any changes need to be made in her feet. She's barefoot. Her hoofs are excellent. She's always had plenty of heel and her toes have never been too long. I do not know what her actual angles are.
I will have to read about OCD Pellets. I just went out and bought a vitamin/mineral supplement to add to her very meager feed rations. Maybe she's lacking something because of the very small quantity of feed she's getting to to her being a VERY EASY keeper.
I appreciate your rambling 
Interesting I just found a vet bill from 5/25/01 that says I had her rear leg (R or L unknown) xrayed because it was swollen. I absolutely don't recall this... there's no other clues on the bill to help me remember what was going on. No medications administered or prescribed.
Here's a picture of Vinni as a 1 1/2 year old (I think she has small pads on her feet at the time of this picture....something people do to young TWH for show/auction I guess) and then as a 10 year old in the show ring.
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Moderator:
DrO
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Posted on Thursday, Jan 22, 2009 - 7:04 am:
Hello Amanda,
The lesions and history are consistent with the old age form of DSLD described in the article. We discuss treatment in the article and your veterinarian may be the best person to decide on rest versus exercise. However if after reading the article you think your horse may be better with a bit of exercise you should discuss this with your vet. I am uncertain why Adequan would be recommended for this problem and yes A-Cell is in the category as the stem cell. It is true that the acute forelimb suspensory desmitis the others talk about is different than the chronic desmitis you are experiencing.
DrO
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Member:
scooter
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Posted on Thursday, Jan 22, 2009 - 7:23 am:
Amanda Legend is hylaraunic(sp) acid. I know it probably shouldn't help DSLD. I believe it does have some anti-inflammatory properties and maybe that's what helped. I kept my mare on it for a year, then switched to the oral form. I haven't had to give her IV injection for a couple years.
It really did seem to make her feel better, whatever the reason, or as Dr.O. points out quite often it could have been coincidence
At this point I would work real hard at getting that extra weight off her, it could make a big difference in her comfort.
Good Luck DSLD is a nasty disease. I hope you are able to help your horse, she's a beauty
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Member:
warthog
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Posted on Thursday, Jan 22, 2009 - 10:25 pm:
DSLD is a systemic disease that affects many many parts of the body. To me it's a bit like Marfan's in humans. It is difficult to diagnose properly unless the vet has a lot experience with it because it may look like an injury. It's not - with ESPA the suspensories and other things just don't heal with the proper molecules under normal use and eventually they get brittle and break rather than stretch.
Check out this website and there is a way to have dsld/espa definitively diagnosed.
https://dsldequine.info/
It would be very important to determine if it really is ESPA because there is a diet that is supposed to help this problem and would be worth a try anyway.
back to stall rest - what we did with our mare who had catastrophic suspensory and probably hip or back injury was to put up six round pen panels with a covered top like a 10 by 20 flea market tent that is staked (VERY IMPORTANT to stake them as they will take flight). we used stall mats on most of the area contoured to drain well on the floor with woody pet or equine fresh pellets on top of the the mats. A small part of the area was open on top so she could go out in the sun if she wanted to. we put our mini mare in with her as company. Next to her in a 12 foot square area was her son who was recovering from colic surgery (a year of very bad luck as her injury was caused by an ice storm and trees coming down and scaring her) so she had company and so did he and they were quite content and they were right outside our front door so we could see them in the house also and keep an eye on them.
I would strongly recommend a mini as a companion but be sure it's one they get along with well and one who is sedate as ours was. a goat can be used also but a mini is generally better I think. If you can't put a mini in with them then you can arrange to put their restricted area up against a paddock with other horses in it so they can touch noses and have company. But be sure to use a heavy tape like Gorilla tape between the tops of the round pen panels so they can't get their head in between two panels and get hurt. This is very important as a friend's stallion broke his jaw in one. You can also put tarps on the round pen panels if it's cold or windy.
Our mare was in the small area for three months and moved to a larger area with our very old mare after that. She is totally sound now but still down in her rear fetlocks from overloading from the injury. We do ride her and she's fine but we're careful with the terrain we ride her on.
So get a diagnosis to see if she really has ESPA (formerly called DSLD). Hopefully it isn't and she will respond well to treatment. Not all DSLD ESPA horses are down in the rear by the way.
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Member:
vinni
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Posted on Thursday, Jan 22, 2009 - 10:59 pm:
DrO, Diane, Warthog, and everyone else who responded,
Thank you for your additional information, ideas to help Vinni, and the little bit of hope you have given me. I think I'll go with my gut this time around and then if she becomes 3 legged lame again then I'll get a second opinion by another Veterinarian that comes highly recommended by a friend (he does a lot of work at Pompano Harness Track with the standardbreds). I wish I had used a veterinarian that I had confidence in in the first place. Not to say the vet I used is not great. For all I know she may be outstanding but I don't know her from Adam and realize I made a big mistake when I called her to come out the first time (The stable I had Vinni at before I moved her home used this veterinarian exclusively and she really helped out during a couple colic episodes). The veterinarian doesn't stand a chance with me since I question everything she does so I wasted my money pretty much.
Vinni sure was acting like she felt great today.
Amanda
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Member:
scooter
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Posted on Friday, Jan 23, 2009 - 6:13 am:
Dr.O Do horses "limp" when they have DSLD and become 3 legged lame? I've never heard of this as a symptom, but haven't read up on it for awhile.
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Member:
frances
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Posted on Friday, Jan 23, 2009 - 7:16 am:
I wouldn't think they'd go 3 legged lame since the problem is bilateral?
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Moderator:
DrO
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Posted on Friday, Jan 23, 2009 - 10:31 am:
warthog, I believe the pathogenesis of old age DSLD is different than that seen in the genetic younger age onset condition, Equine Systemic Proteoglycan Accumulation, seen so often in Peruvian Paso. Note as a symantec issue that horses with ESPA may not present with active DSLD until later in the disease process. It is not that the DSLD has been replaced with ESPA, it is that the former is one of the disease presentations of the latter once it gets to the point that the suspenders become sufficiently weak and damaged to induce inflammation. I do think your post is good as it points out that this condition in not primarily a inflammatory disease.
Diane and LL why would horses with DSLD and/or ESPA be protective for a horse getting remarkably lame in a single leg? It does not rule out the problem but instead is a not uncommon presentation when one leg's weakened suspensory becomes injured.
DrO
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Member:
warthog
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Posted on Friday, Jan 23, 2009 - 2:53 pm:
One of our vets used a different term for the "old age or overwork" problem with suspensories. I can't remember what it was but it wasn't DSLD. He was a South African race horse vet and saw a lot of suspensory problems and said that the study of incidence of DSLD in different breeds was very flawed because it included injuries from overuse as well as "real" DSLD. So what term might he have used instead of DSLD for the suspensory damage that occurs from overuse particularly in standardbreds???
And all the lit I've read indicates that DSLD is bilateral or quadralateral so three legged is a strong indicator that something else is going on also. A friend owned a Peruvian that did have a suspensory rupture in one leg and this would indeed cause the three legged problem but you cold see the damage in both legs before the rupture.
I really hope they figure this one (ESPA) out because I can personally name six people who had to put down Peruvians because of it and they were very young (5 to 8 years in some cases) horses and the owners were devastated.
I would hope this problem is just overuse and rest will take care of it as it did with our mare.
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Moderator:
DrO
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Posted on Sunday, Jan 25, 2009 - 11:58 am:
Hmmm, no I don't know what term that might be but if it was a "degenerating suspensory ligament" then calling it a degenerating suspensory ligament desmitis would seem appropriate. He may have been labelling a chronic unresolved acute desmitis that does not have a significant degenerative component? Let's call it a chronic desmitis. Of course DSLD, whether the old age type or the ESPA type, is also a chronic problem so I am not sure how much elucidation there is here.
DrO
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Member:
warthog
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Posted on Sunday, Jan 25, 2009 - 10:10 pm:
thanks.
I guess really we just need to work on identifying all the espa caused DSLD cases since the mechanism is so different from the old age type.
I was told by another vet that you can actually feel the thickness and hardness in the suspensories caused by the espa.
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