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Discussion on Localizing pain with a computer
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Member:
equinkel
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Posted on Wednesday, Aug 19, 2009 - 2:18 am:
Hi Dr O,
I posted several months ago about a mystery lameness in my ottb. Previously we blocked and flexed on several occasions and the lameness went from RH, Left suspensory, and possible knee chip. I finally got a new vet out for a second opinion. He brought a new piece of equipment that is computer based and has sensors on the head, hind, and left foot. It shows the results on a computer about how much lameness shows up on which leg and as you start the blocks it shows you how much of the lameness diminishes. Based on the computers/vet findings my horse went 90% sound after blocking the coffin joint and the PDN. After our findings we did xrays on the left hoof. The vet said my horse has extremely long toes and no heel support and corrective shoeing will help a lot. He said to cut the toe down (all at once) and extend the shoe back to give more heel support and heels should be raised slightly. He also wants to treat this by injecting the coffin joint and the bursa joint* (I forgot the name of this one)He said this should allow the horse to return to some work and small fences. My question to you is what is the likelyhood of this costly injection being affective, how long will it last, do you agree with the diagnosis based on the findings? Also, do you agreee to cut the toe back all at once to make the correction? How should I go about this? Is this considered navicular or something else? Sorry for the book.
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Moderator:
DrO
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Posted on Wednesday, Aug 19, 2009 - 3:04 pm:
Hello equinkel,
We are about to enter an age where lameness exams are going to be much less subjective using computers, motion analysis equipment, and software. Though I see the localization to the foot and note the hoof conformational problems I don't see a actual diagnosis as many structures are blocked with these two blocks.
Many horses with such conformation have chronic heel pain. They do improve significantly with having the hoof properly balanced. Sometimes the help of NSAID's is needed. As to whether the joint or bursal injections will help depend on the degree that arthritis and bursitis contributes to the lameness. I don't see that information in your post and it can be hard to quantify sometimes. Often you can attempt conservative therapy then if more aggressive therapy needed institute it then. For more on this, assuming this is the diagnosis, be sure to study the article associated with this discussion.
Be sure to follow the link in that article to Diseases of Horses » Lameness » Diseases of the Hoof » Correcting Long Toe Low Heel Foot Conformation. It explains much about the questions you have on adjusting the balance.
DrO
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Member:
brandi
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Posted on Wednesday, Aug 19, 2009 - 10:11 pm:
equinkel, I have a severe navicular disease horse (diagnosed on both radiographs and ultrasound, plus clinical signs). IF you are sure that you have well-balanced trimming and competent shoeing (your vet should agree that your farrier has done a decent job, and be sure it's in line with whats posted in Dr.O's article), and your horse is not significantly better, then I can say first-hand that navicular bursa injections can make some horses dramatically more comfortable. In 2005 when I was still able to ride my boy, I had his bursas injected for the first time. The first ride after his injections was like riding a new horse - I had never felt him feel so good - I literally cried. It was that dramatic. Now, to be fair, it did not last more than a few short months with Apache, but again, his disease is quite severe.
My personal thoughts are if your horse is not trimmed and balanced well, and not shod to improve what can be improved upon (breakover, heel support, etc) then that needs to be addressed immediately. Don't let any time pass before addressing these things, you can't get back any damage done. And don't ever risk sticking a joint when you haven't addressed these things first - joint injections carry a risk and shouldn't be taken lightly. I have my navicular bursas injected only by a practiced surgeon, who has the "touch" necessary to find and feel a good "stick" - which is hard in the nav bursa. He also does an extremely solid surgical prep - what I want any time a needle is going into a joint. Do what you can and do it right. When you get to the point you can't do any more, the helplessness quite frankly, just sucks.
I am extremely passionate about this subject because I have been battling this with my Apache for 6 years, and he has recently undergone experimental surgery to alleviate pain (he is not a candidate for denerving). We had success with his first foot, but not with the second, the left, and my god-send surgeon agreed to try it again Friday to see if we can help him on the left. He's still recovering, obviously, so we'll know in a couple of weeks if we've helped him. We're doing all of this just to make Apache more pasture sound, and hopefully for the help of some horses in the future, but this is my last resort. After this, all I have left is to watch him get more lame and closer to THE day. He is a big, beautiful, perfect creature, only 13 years old, and does not deserve this terrible disease.
One last thought, my surgeon feels very strongly that nav bursa injections can really help some horses, he has had very lame horses go quite sound for years, one in particular with just one set of injections. We just discussed this in Apache's surgery on Friday. But I also know he would feel just as strongly that balanced trimming and proper foot support is the first line of defense.
I wish you the best with your horse.
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Member:
dres
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Posted on Thursday, Aug 20, 2009 - 5:44 am:
Brandi, so glad to see you up and active again on the list.. your words / passion come thru loud and clear.. 
Your Apache, sounds much like my 10 year old gelding that has been only serviceably sound now since he was 4 years old.. I manage him now with corrective shoeing / balancing and butte a couple days a week..
If you could DrOp me a line to let me know what surgical procedure you did other then nerving him .. I would love to hear about it..
Thanks .. Ann
On the first day God created horses, on the second day he painted them with spots..
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Member:
brandi
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Posted on Friday, Aug 21, 2009 - 10:55 am:
Hi Ann, I tried to email you but it got kicked back. I figured it wouldn't hurt to share with others, but I'm going to start a new post - I'll entitle it "experimental surgery" or something under this nav disease area.
Brandi
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Member:
dres
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Posted on Friday, Aug 21, 2009 - 11:03 am:
darn.. that is the correct email too.. sometimes my friends have told me that the mail gets bumped back .. later on will go thru.. ugh .. love this new area we live in..
On the first day God created horses, on the second day he painted them with spots.
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Member:
brandi
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Posted on Friday, Aug 21, 2009 - 11:05 am:
You're quick - my other post is up.
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Member:
equinkel
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Posted on Saturday, Aug 22, 2009 - 4:03 am:
The farrier and the vet are coming out monday to do their corrective shoeing. I wonder if my horse will need a lot of time off after cutting the toe back. If so, what's the point of getting the expensive joint injection? I would like to hear about other people's experience with this.
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