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  Discussion on Post injection lameness
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Member:
Caymie

Posted on Tuesday, Sep 13, 2005 - 11:19 pm:

Hi Dr. O.,
I would love to hear your thoughts on this because I just think it is too weird. Three weeks ago, my horse had a right rear lameness. The vet blocked his fetlock, and then his hock. He blocked the lower two hock joints, the ones usually involved with bone spavin. The block improved the lameness by about 90%. He was radiographed and found to have very mild bone spavin in that hock. One week later, the vet injected the hock with HA and Triamcinilone. I rested him for a few days and then walked him under saddle and did some light trotting. He felt fine under saddle. On Monday, one week exactly after the hock injection, I discovered that his right hind was very swollen from his hock down to about a third of the way down his cannon bone. I took his temperature, he didn't have a fever. There was no cut, hair loss, etc any type of outside indication of trauma. I gave him two grams of bute and rested him for the next day. On Wednesday, I attempted to ride him, the swelling had gone down. He was a mess under saddle, riding him made him very lame, (whereas prior to the injection, he would work out of the lameness), and he was even worse off than he was prior to the injection. I rested him for two more days and he was almost sound, with a little bit of lameness on the circle. I took him to the teaching hospital today for further evaluation. He went sound with the exact same block that we had done three weeks ago to diagnose the bone spavin. He also had a much more violent reaction to the joint flexion than he did when the bone spavin was diagnosed. When they injected the anesthetic into his hock, some blood came back into the needle along with the joint fluid. He is now on bute for ten days and stall/paddock rest. They think that he must have done something traumatic. I find it very strange that this is the same joint that blocked out before the hock injection. Is seven days to long for some type of flare to develop? Can you have a flare following a joint injection without a fever? Would a flare make him even more sore/lame than the original mild bone spavin? Could the blood in the joint fluid just be from hitting something like a blood vessel while inserting the needle? The vet said the needle went into the joint very smoothly so I wonder. What do you think? Could this be some kind of weird reaction to the injection or is it possible that the injection went somewhere other than where it was supposed to? This is our weirdest episode yet. I would appreciate any suggestions that you might have.
Thank you,
Mary
Moderator:
DrO

Posted on Wednesday, Sep 14, 2005 - 7:27 am:

Though it does sound like coincidence the remarkable swelling in the leg suggests that there was something else acute going on beside the hock and hock injection. Even if infection has gotten in the joint I would not have expected such generalized swelling.

But then again I would not completely rule it out. No, 7 days is not too long to develop flare and the lack of fever is consistent with a non-infectious cause. Yes blood, particularly at the beginning of the tap that clears as the joint fluid drips out, is a common event and represents extra articular blood. Uniform blood in all the fluid is more likely to be from within the joint and would be consistent with a traumatic event. What was the cytology of the fluid like on the second tap? As long as it did not indicate infection, bute, cold wraps, and stall rest would be logical treatment to cool down the joints.
DrO
Member:
Caymie

Posted on Wednesday, Sep 14, 2005 - 7:38 am:

Hi Dr. O.,
I believe that a flare is exactly what he developed. That is just too much coincidence even for Caymann. He is just not a horse that hurts himself in turnout. And the lack of a cut, hair loss etc. makes me even more suspicious. So, my final questions are, can a flare be that acutely painful? And does this mean we will have to reinject him once the flare subsides? How long does this normally take? How is flare different from an actual joint infection?
They did not do a cytology on the fluid from his joint to my knowledge.
Thanks so much!
Mary
Moderator:
DrO

Posted on Thursday, Sep 15, 2005 - 6:34 am:

The problem with the idea of joint flare is that the swelling you describe in not typical and strongly suggests something outside the joint. Sometimes when a joint is injected the body reacts with inflammation to the chemicals, infection is not involved with this type flare. Yes, these horses can be very lame and this usually resolves in 3 or 4 days with oral NSAID's.

If I suspected a reaction to the injection I would be slow to think another injection sensible.
DrO
Member:
Caymie

Posted on Thursday, Sep 15, 2005 - 5:34 pm:

Dr. O.,
I would agree that this seems strange, but the idea that he somehow injured the exact same joint that was injected six days prior is even stranger to me. My horse never does anything by the book-my vet can attest to this. He has been on stall/paddock rest since Tuesday with 2 grams of Bute each day. I am going to take a look at him tomorrow on the lounge line to see how he looks. We shall see. I hope that this doesn't mean that he would automatically have a similar reaction if we need to inject that hock again in the future because he does have some very mild bone spavin. He has never had this hock injected before. Thanks for the advice.
Mary
Member:
Caymie

Posted on Wednesday, Sep 21, 2005 - 12:17 am:

Hi Dr. O., (and Fran)
They are going to tap Caymann's joint tomorrow because he continues to be quite sore when taken off of the Bute. Once they have the results from that, they will decide what to do next. Just when I think that things can't get any wierder. I'll let you know what happens.
Mary
Moderator:
DrO

Posted on Wednesday, Sep 21, 2005 - 7:16 am:

Thanks Mary, take heart, I consider it a good prognostic sign that the bute does relieve the lameness. The more I look at the above the more it sounds like an injection reaction, but perhaps the injection did not make it into the joint?
DrO
Member:
Caymie

Posted on Wednesday, Sep 21, 2005 - 7:40 am:

Oh my gosh Dr. O.,
I had the exact same thought and am going to present that idea to the surgeon today!!!!!!!!!!
You are better than therapy in helping me think that I am not crazy. If the injection didn't make it into the joint could that cause this type of reaction? Could it still inflame the joint? Could part of it have gone into the joint, but not all of it? Whatever it is, it is causing him more pain than just the initial bone spavin. It's funny, because I remember that the vet had a bit of trouble getting the anesthetic into the joint when he initially blocked it. But when he injected it one week later, it went in so smoothly on the first try that I actually thought to make note of it. And given the response to the joint block, I kind of figured that I would feel a much better improvement under saddle than I did. I think that Caymann will be OK but I think we had better get this figured out-QUICKLY. I'll let you know what happens.
Mary
Member:
Canter

Posted on Wednesday, Sep 21, 2005 - 8:10 am:

I'm hoping for the best Mary!

~Fran
Member:
Caymie

Posted on Wednesday, Sep 21, 2005 - 9:50 am:

Thanks Fran.
Mary
Member:
Caymie

Posted on Thursday, Sep 22, 2005 - 9:50 am:

Hi Dr. O., (and Fran)
Good news, the joint tap shows no infection and minimal inflammation. The vet put some antibiotic into the joint since he was in there anyway just to be safe. Do you think it is possible that the injection didn't make it into the joint, therefore the periarticular swelling and return to lameness? Could the injection not making it into the joint have caused him to be so sore? I figure that either it did make it into the joint and he had a reaction to it, or it didn't make it into the joint and so the original lameness returned only it was worse due to the extra inflammation. He will be on bute and rest for a few more days and then I will see what he looks like. I figure he will either be sound or back to where he was prior to the injection. If that is the case, I will exercise him lightly with bute for a month and then we will reinject that hock with depo. I will have that done at the teaching hospital just to be safe. I would love to hear your opinion on this. I am feeling very relieved.
Thanks,
Mary
Moderator:
DrO

Posted on Friday, Sep 23, 2005 - 7:44 am:

It is possible Mary, and I believe it would still be a odd reaction, neither steroid nor hyaluronate should be irritating out of the joint. It sounds like a plan and I would be sure he is on bute the day of the repeat IA injection and for several days after. Though I have not had such a flare as you describe, I have seen transient increase in stiffness which the bute prevents.
DrO
Member:
Caymie

Posted on Friday, Sep 23, 2005 - 8:56 am:

Dr. O.,
I will definitely make sure he is on Bute prior to and for several days after the injection. It is going to be very interesting to see how he looks next week once he is off of the bute. I guess I will either have a sound horse, or a horse that has returned to his pre-injection state without the added acute pain that showed up a week after the injection. Stay tuned-I'll let you know.
Thanks,
Mary
Member:
Caymie

Posted on Monday, Sep 26, 2005 - 9:52 pm:

Hi Dr. O.,
Well, Caymann chose the answer behind door number two. He is sound on Bute, but back to his original lameness (which now looks a bit worse)off of it. I'm sure the fact that his hock has had a needle in it four times over the past month is not helping. Now I am convinced he had a reaction to the injection and so is the vet.
He is going to have Bute for another week and pasture turnout. The vet said I can ride him at the walk but no more than that. I do not really want to have to keep him on Bute for another month, and even if I did, riding him on Bute is probably going to exacerbate the inflammation since he won't feel as sore. We are going to reinject the hock in a month if it seems as though things have quieted down. Or they may not quiet down until he has another injection. I will Bute him several days prior to the injection and several days after. Does that seem reasonable to you?
Thanks,
Mary
Moderator:
DrO

Posted on Tuesday, Sep 27, 2005 - 8:51 am:

Absolutely, I would also consider an Adequan injection (IM of course) and oral joint supplements if you have not already.
DrO
Member:
Caymie

Posted on Tuesday, Sep 27, 2005 - 12:42 pm:

Dr. O.,
He is already on a joint supplement and receiving monthly Legend and Adequan. It is time for his injections so I will make sure he has both this week. Good timing, huh? I'll keep you posted. Thanks for the help.
Mary
Member:
Angel77

Posted on Thursday, Sep 29, 2005 - 1:22 am:

Dear Mary,

If you are able to administer IV shots yourself, then I would suggest you order your Legend thru Smart Pak. 1-800-461-8898. You will need your vet to fax in a RX for the Legend. I usually have the vet refill my RX when he is out to my ranch giving vaccinations. Cost is around $75 per vial and they send you a needle & syringe for each vial ordered. I also get all of my other supplements, fly spray, etc from Smart Pak Equine.

With my horse I have found the savings to be quite substantial considering he has been on Legend for almost three years. Injected once a month.

I also use Amerdon Rapid Response T. If you call and order you will also receive RR for humans as a free trial. It is a great joint supplement for me as well as a wonderful digestive aid for my stomach. I have only been on the human RR for about two months. Let me tell you--I feel so much better.

Sharone who is head of Amerdon is a very nice lady. She will answer any questions you may have about the products available her #1-800-331-1036. Please let her know that Wendy From the Palisades in Calif referred you. Even though it cost $279 a gallon. It has been worth it. My horse has been sound as a dollar. He has calmed down considerably while jumping. He has gained so much strength and muscle. In addition my farrier says my horse 11yr old geld and the 28 yr old mare that I take care of both have the healthiest feet he has ever seen. It has been almost three years since I have had to have the vet inject his hocks. Aly has been on the RR for almost three years. I am truly a believer in this product.

Good Luck to you in whatever you decide to do.

WTG
Member:
Caymie

Posted on Thursday, Sep 29, 2005 - 1:07 pm:

Hi Wendy,
Thank you for your suggestions. I will look up the website for Rapid Response. I too get my supplements (most of them)through Smartpak. I love their system. However, I am able to get the Legend here in Colorado for about $56.00 a vial. And that is one thing I actually pay my vet to do. I am very comfortable doing IM injections, but not the IV. It would be nice if I did feel comfortable doing it because I could save on the call charge. But it's just not worth it to me.
Thanks again-
Mary
Member:
Angel77

Posted on Saturday, Oct 1, 2005 - 7:22 am:

Dear Mary,

Who do you get your legend from?? It would save me $25 a month if I could get it from your source.

IV shots are actually very easy if your taught the right way. If you are good at IM maybe your vet can teach you IV so you feel comfortable enough to administer IV on your own.

In any case how is your horse? Hope whatever you are doing is helping your horse.

WTG
Member:
Caymie

Posted on Saturday, Oct 1, 2005 - 2:01 pm:

Hi Wendy,
I get the Legend either from my ambulatory vet who works at Colorado State University, or I buy it from a vet supply store called Mountain Vet, in Fort Collins, Colorado. Last month I paid about $56.00 per vial. The phone number for Mountain Vet is (970)484-2200. I was just there today and they reported that Legend is running about $62.00 a vial if you purchase a box of six vials, or $67.00 for a single vial, so it has gone up a bit. Adequan is $41.25 for as single vial or $37.00 a vial if you buy a box of four.
So it may have gone up at the university as well I'm not sure because I have been buying it at Mountain Vet. Where do you live?
I know that my vet would be happy to teach me how to give an IV injection, I have actually done it in the past, but it has been so long I don't really feel comfortable doing it. I may think about having him show me.
My horse is doing much better, thank you. We have been giving him pasture rest and a series of Legend and Adequan injections (IV) and he has returned to his pre-injection state of lameness, which is good. He acutally may even be better than that becuase he has been resting. So, I may try to manage him this way for awhile, to postpone another intraarticular injection for as long as possible. I might consider using some Surpass and/or shockwave too. However, I do want do what's best for his joint health in the long run, so I suspect we will reinject that hock eventually. I will have it done up at the school just to eliminate another variable.
How much Legend do you need per month?
Mary
Member:
Angel77

Posted on Saturday, Oct 1, 2005 - 6:51 pm:

Dear Mary,

I use one vial of Legend every month for my 11yr old geld jumper. He gets the maintenance dose of RR 2oz daily. If he is sore or after a horseshow he gets 3-4oz for a few days and then back to the maintenance dose.

I agree with having horses hocks injected if that's what they need. For the long run as I mentioned I swear by Amerdons Rapid Response.

Personally I have witnessed amazing transformations occurring for many different horses at several different barns who are on RR.

As I mentioned before my horse has not had to have his hocks injected for three yrs-since he has been on the RR. His over all health is impeccable even though he just lost his left eye June 1, 2005 due to a stall injury. Two weeks later he was jumping again. I kept him at 3' for three weeks and now he's back to 3'9 oxers,full courses,triple combinations,and six fence jumping lane no problem. This horse loves to jump his heart out.

In fact my farrier says that both my horses have the healthiest feet he has ever seen. My farrier shoes for many top Grand Prix horses. He was there earlier this year shoeing for the Las Vegas World Cup Finals 2005 When MMBeerbaum won the Gold. So I feel very blessed to have one of the greatest shoers ever.

I live in Malibu, Calif.

Thanks for the info. I'll call on Monday.


Good luck

WTG
Member:
Caymie

Posted on Saturday, Oct 1, 2005 - 7:58 pm:

Hi Wendy,
I suspect just about everything costs more in California:-) There are a lot of people in Colorado who have moved here from there and like it because they think it is "cheaper." (Except for Boulder). I guess it's all about your perspective because people from the south and midwest think it is more expensive here. But I have a cousin that lives in your area and it is beautiful.
Anyway, I am going to research the rapid response. I hope the info on the Legend was helpful. And I think it's really cool that your horse loves to continue jumping even though he lost an eye. You must really trust him and he must trust you.
I hear you about feeling fortunate regarding your farrier. I always tell mine that the day he quits shoeing is the day I give up riding.
Thanks for your help. This is a great site.
Mary
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