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  Discussion on Newly diagnosed arthritis - HELP!
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New Member:
Mleeb

Posted on Thursday, May 4, 2006 - 2:29 am:

Hi all,
New to this forum, so I hope I'm not breaking all the rules in the first post. I have spent several hours reading everything (I think) relevant to arthritis and treatments, but I still have questions that aren't answered. Here's the history: In October I bought a 12 yo QH gelding, 15.2 hh, well muscled, very correct conformation, excellent feet. He had previously been a reiner, a rodeo pick up horse, and a PFRA ranch horse, and had been doing nothing for 12 months. I was given a week to try him out and put him through his paces. We did spins, transitions, flying lead changes, ran barrels, and moved cows. He loved every minute of it and was hands down the best horse I've ever ridden. I took him to the vet and he passed the vet check, so I bought him. He was basically parked all winter with 4 other horses. In March he was suddenly lame and went from grade 1 to grade 4 in about 2 weeks time. The farrier came and did his feet and found no problems at all, said they were exceptionally good. I made an appointment with a different vet this time, and he immediately targeted the problem and did x-rays, diagnosing my horse, Doc, with chronic arthritis of the short pastern at the joint where it intersects the coffin bone. There are holes in the bone and a spur is forming. From there, Doc went on Bute, 2 gm per day for 5 days, and a few days after that went back to the farrier for a set of bar shoes, as recommended by the vet, who said he also had bruising in the heels. The vet is not very optimistic, saying the prognosis is not good, and he may only ever be pasture sound. However, I just bought this horse and had big plans! I'm willing to downsize them in an effort to keep his quality of life in good shape, but not to give up completely! I understand from reading posts that this joint is not a candidate for fusing, and understand from my vet that it is very hard to access for injections. I guess that would leave IM instead of IA, but that's OK. He suggests giving Bute 1 gm in the morning on the day I wish to ride and that's about it. He has previously been a vet at the race track, so has extensive horse experience. When I mentioned HA injections, he said in his experience it worked on young horses temporarily sore, but not on established arthritis. He then suggested steroid injections, one in spring, one in summer.
Anyway, that's the story. I now have a million questions, maybe someone out there has been there and has an opinion for me. When he's good enough to ride, do I use Bute anyway, and how much and when? What type of exercise, and how much, should I do to keep him in shape? (He's not overweight.)Should I use support boots of some type? Should I apply ice after riding, or would heat be more appropriate? Are ice and heat even going to work on a joint so inaccessible? And if he was so fabulous under all that work in the fall, how can he never be more than pasture sound now? He's been wearing the bar shoes for about 4 weeks now and improved a great deal. He's on pasture 24/7. He now varies between good days where you would never know he was arthritic, and days I would call grade 1 lame. Yesterday, for the first time, I brought him into the arena to lunge and see how he was moving, and he volunteered to show me how fast he could free lunge instead, and did it all at a dead run. The hitch in his stride showed only at the trot. Obviously he was feeling better.
I hope I covered it all. Any help?
Michelle
Moderator:
DrO

Posted on Thursday, May 4, 2006 - 11:03 pm:

Michelle, you describe the coffin joint. This is not a difficult joint to block and treat and it does not sound like the joint was blocked, an important diagnostic step.

Information on how to approach treating horses with bute chronically for arthritis along with all our other suggestions are in the Arthritis Overview article associated with this forum and continued in the articles on specific therapies. There are links to these in the overview article. Treatments, as you list, are not thought to be useful.

Considering the poor prognosis of horses with DJD of the coffin joint I would consider taking the horse for yet another look to someone who is comfortable injecting this joint, or at least have the radiographs reviewed. We do have an article on this specific type of arthrits so if you have not seen it yet see Equine Diseases » Lameness » Diseases of the Lower Limb » Ringbone.
DrO
New Member:
Mleeb

Posted on Friday, May 5, 2006 - 12:03 pm:

Hi Dr. O,

Thank you for your reply. It's such a relief to hear from anyone, especially someone with an education in veterinary medicine. I typed a nice detailed reply and lost it somehow, so here I am starting over.

1. "Michelle, you describe the coffin joint. This is not a difficult joint to block and treat and it does not sound like the joint was blocked, an important diagnostic step."

Your're right. The joint was not blocked on examination. I didn't mention that it was the left front before, sorry. My vet said that if he did a block, the horse would show lameness on the RFF instead, as it was very, very likely this problem was bilateral. Also, the x-rays were only done of the LFF. Would blocking it make a difference in the diagnosis, and as a result, the treatment and prognosis? You said "Block and treat," what methods of treatment were you referring to? I have begun to believe that bute or other NSAIDS are the only likely option.

2. "Considering the poor prognosis of horses with DJD of the coffin joint I would consider taking the horse for yet another look to someone who is comfortable injecting this joint, or at least have the radiographs reviewed."

Injecting with what? What would you be hoping the second opinion might reveal?

3. "We do have an article on this specific type of arthrits so if you have not seen it yet see Equine Diseases » Lameness » Diseases of the Lower Limb » Ringbone."

As per your suggestion, I have read the majority of the articles under this heading. I hadn't thought that DJD of the coffin bone was synonymous with ringbone, and even after reading the articles, I'm still not sure. Is it the same thing? If so, would this be high ringbone?

During the course of this reading, mention was made of laparoscopic surgery - is this a viable option for removing the developing spur? Or, is fusing an option? I know it's covered in other articles, which I have also read, but again, I'm not clear on if this joint is a candidate. Many different joint names were used, and I eventually became confused at to whether the coffin joint was being identified by another name. My understanding was that it has low mobility, but it DOES move, making it a last resort operation that may make a horse comfortable, but not a riding horse.

Just to summarize, this is what else I've come up with. Please let me know if I'm going in the right general direction, or completely off in outerspace.
A. Bute or another NSAID is likely the best option. Use the smallest dose that will keep the horse comfortable, preferably not for long periods of time, and hopefully with at least 2 consecutive "Rest" days in the course of a week.
B. Bute will require approx. 1 hour for minimal effectiveness, will possibly be at maximum effectiveness in 3-4 hours, and might last 10-12 hours. A 2 gm/1000 lbs of horse per day, is the maximum dose and not to be continued except under veterinary direction.(But should a horse given a pre-exercise dose also have a post-exercise dose when it has been a long day of work?)
C. Legend, Adequan etc has zero to minimal chances of effectiveness in this type of disease, and the cost is prohibitive.
D. Glucosamine, chonDrOitin etc may be beneficial, but really it's a guessing game and so much depends on the horse, the disease, etc. etc.
E. Long warm up periods and cool down periods on days of riding/exercise are beneficial.
F. Medicine boots and the like are probably NOT much help.
G. Pasture turnout 24/7 is ideal (which we have here), regular exercise is also good (but HOW regular?)

I hope I got it all down. Two last questions: When my horse is capable of walking and loping comfortably around the pasture, and shows only a moderate head bob at the trot, I consider him be doing alright out there, and not requiring any bute. Would you agree? And last, would ice, cold water, or some type of liniment applied after exercise be of any help?

Thanks very much for your advice

Michelle
Moderator:
DrO

Posted on Friday, May 5, 2006 - 4:27 pm:

1. If it does not block out, then the diagnosis is wrong.
2. The article explains the different treatment options for joint injections.
3. Ringbone is the horseman's term for chronic arthritis of the coffin and pastern joint after bony enlargement occurs, which will occur if the diagnosis is correct.

As to your summary and your following questions, it all depends on the diagnosis which remains uncertain. I am worried because you seem to have been given misinformation: coffin joints are not hard to hit and, in your last post, arthritis of the coffin joint is not frequently bilateral and if it is I would want to know it. Are you sure he was not talking about diseases of the navicular region, then these two statements would be correct.
DrO
New Member:
Mleeb

Posted on Friday, May 5, 2006 - 5:59 pm:

Hmm. I thought I had clearly understood what he said, and what I was shown on the x-rays regarding the area of the damage. Heck, I can see it my mind right now. You have raised some good points, though. I have had a message in for the vet to call me for about 2 days now. He's pretty busy right now, spring is hectic, so I imagine I will hear back from him by Monday or Tuesday. I will double check with him that the damage is/is not in the navicular region, and re-post when I get an answer.
Thanks
Michelle
New Member:
Mleeb

Posted on Tuesday, May 9, 2006 - 9:17 am:

I have thought of something else now, just to clarify (still haven't reached the vet). If he tells me that the disease is in the navicular region, should we be going back and blocking it for further diagnosis? Or, is that only if it is in the coffin joint? Could blocking it reveal a diagnosis so different that our treatment would be different, or are we still looking at NSAIDS, steroids etc?
Michelle
Moderator:
DrO

Posted on Wednesday, May 10, 2006 - 6:48 am:

It is not the location that determines the treatment as much as the cause of the lameness: if it is an inflammatory problem, NSAID's and steroids are rational therapy. Further blocks may be indicated depending on what the veterinarian says.
DrO
Member:
Mleeb

Posted on Wednesday, May 17, 2006 - 6:12 pm:

I finally got to talk to my vet today, a whole 5 minutes in between his other appointments, so I hope I got all the necessary information. He verifed what you suspected, Dr. O, that this is arthritis in the navicular area and the prognosis as such is not good. I told him how my horse had not been on bute for several weeks, but I had given him 1 1/2 gm prior to riding him two weeks ago, and it was not effective. I told him that I had given him 1 gm each morning for the last 3 mornings, just for the sake of trying something and seeing if it helped. Doc is actually worse today that he was yesterday, so obviously this isn't it. He suggested giving him 2 gm of Bute, waiting 6 hours, and riding. Or, if I want, 1 gm the evening before, and 2 gm in the AM of the day I'm going to ride, and no Bute at all on the days I don't ride. If either helps, then his advice is to use the Bute. If neither helps, he is willing to try hyaluronic acid and/or cortisone, which I would likely then boost with Bute when required. Can anyone add anything to this that might be helpful? When I mentioned glucosamine and similar products he said it wouldn't hurt, but for the cost of doing it, it probably wasn't worth my while. My thought is, if cost isn't an issue, will it be beneficial enough to use it? I can buy Corta-Flx (liquid) here at the vet clinic - do horses like it enough to eat it? If I have to syringe it, I won't want to use it.
Member:
Caymie

Posted on Wednesday, May 17, 2006 - 11:27 pm:

Hi Michelle,
I don't know if my horse has a similar problem to yours, but his lameness was greatly improved with navicular bursa injections. He is a twenty three year old quarter horse who I acquired to be a friend to my warmblood. He blocked out to a PDN block and had pretty severe changes in the navicular bone in his right front, and mild/moderate changes in his left front on radiographs. He is pretty much a textbook case of navicular disease. We tried coffin joint injections for awhile, and they did help at first, but eventually were not very effective.
The change in his lameness following the navicular bursa injections was pretty dramatic. My farrier added some equithane to his wedge shoes in front and he looks like a totally different horse. Hope this helps-
Mary
Moderator:
DrO

Posted on Thursday, May 18, 2006 - 6:33 am:

As new diagnostic tests and tools have been developed we are doing better at more accurate diagnosis, treatment, and prognosis. We have a article on navicular synDrOme and recommended treatment/management ideas, see Equine Diseases » Lameness » Diseases of the Hoof » Navicular Disease / SynDrOme.
DrO
Member:
Mleeb

Posted on Thursday, May 18, 2006 - 9:17 am:

Mary, were you injecting cortisone? What is equithane? I have never heard of it.
Member:
Suzeb

Posted on Thursday, May 18, 2006 - 10:02 am:

Michelle,
For a description of equithane go here:
https://www.cottamhorseshoes.com/equithane.htm
Member:
Caymie

Posted on Thursday, May 18, 2006 - 12:20 pm:

Hi Michelle,
They injected both of his navicular bursae with a combination of triamcinilone, depo-meDrOl, hyaluronic acid and amikacin. They had to do it using radiographs so they can see exactly where the needle is going. It was done at the Colorado State University Veterinary Teaching Hospital. I see that Susan has already directed you to the site for equithane. In his case, the majority of the improvement came from the injections and the shoeing finished it off. I don't know if that would be the case with every horse, but that was our experience. Good luck and let us know what happens.
Mary
Member:
Mleeb

Posted on Thursday, Jun 15, 2006 - 9:20 am:

I thought I would post with an update. Doc had remained unchanged in his lamness, sometimes bobbing lame at the walk, sometimes only at the trot, until this past weekend. On Friday I took him to the vet for an IV injection of hyaluronic acid. By Sunday, he was moving better and seems to still be doing so as of last night, Wednesday. At the walk he was moving at a very relaxed pace (all of this is in the field and on a lead rope), but not bobbing lame. His ability to turn has also improved substantially, but there is still obvious lamness there. Yesterday the farrier arrived and we put on natural balance shoes with pads (ouch! what a price tag!)By the time all my other horses had had their trims, the farrier took Doc, jumped on bareback, and rode him around to check him out. He was moving better, again, than he had before shoeing. In fact, he was moving more comfortably than I had previously been able to achieve with 2 gm of Bute. The farrier then made a comment on something I had thought earlier and dismissed, which was that it looked like he was stiff in the shoulders more than anything now. He recommended a chiropractor, which I will definitely do. That's one month from now, however, as he only comes around monthly and was just here last week. So, now I wait and watch again, and in 2 weeks will do another IV hyaluronic acid. I haven't yet started him on any glucosamine product, but plan to do so in the near future when there is a window of time that doesn't have another treatment method going on, just so I will be able to tell which treatment may or may not be helping.

My vet, who has always gives the worst possible outlook, has apparently phoned the farrier for a consult on what's going on. The vet never lets on that he does this, but the farrier always tells me when he's talked to him. Apparently in the last conversation he asked the farrier if he had told me about HA? When the farrier said no, the vet said that I was very well informed, and must do a lot of research. To which the farrier replied, that sometimes I asked him questions that had him thinking for a while, too. So, now I pass the compliment on to you, Dr. O, and your great web site, and all of you who post and share your info and experiences. While I do research other internet sites, this has become the place I go to first, and then return to re-read everything at least twice. Thanks to you all!
Moderator:
DrO

Posted on Friday, Jun 16, 2006 - 11:57 am:

Glad to hear Doc is better and thank you for the kudos Michelle. If arthritis is the problem I do think the oral supplements as outlined in the article will be of benefit.
DrO
Member:
Mleeb

Posted on Sunday, Dec 3, 2006 - 11:53 pm:

Hi all,
Just posting another update. I continued Doc on shots of HA (Map5) once a month through to September, and it worked really well for him. Since August he has been barefoot (the wonderful farrier moved away) and except for one ride where he showed tenderness on a stretch of gravel, has been sound this way. In August I started him on a liquid glucosamine supplement, and he's been on it daily since then. Throughout it all, he has remained sound. He had very few rides throughout the summer, maybe 6, but as of September he seemed to have been consistently well for a long enough period of time that I thought I would ride him some more. Since then he has gone on cattle drives and team penning, and rides in the stubble fields with my kids and their horses. While he's had a time or two where he wasn't 100%, he's never been lame, and more than once surprised me with his spirit and energy. It was such a thrill to ride him this way again!
My vet had advised giving Bute before a ride, but I've found lately that it makes no noticeable difference in his comfort level, but makes him so dopey it's like giving him Valium. After our last cattle drive when he had worked really hard, I gave him the Bute AFTER we were done, hoping it would help with some post-exercise stiffness. I don't know if it did or didn't, but I felt better, and he looked to be moving comfortably in the field the next day.
It's hard to believe this is the same horse that my vet said to nerve or can. I only hope it lasts a while, preferably years.
Moderator:
DrO

Posted on Thursday, Dec 7, 2006 - 7:19 am:

Since phenylbutazone (bute) as a cox inhibitor does not have any sedating effects, I wonder about the behavior change and find it most likely coincidental. By giving bute before exercise you might slow the progression of the arthritis and less likely you will find yourself with a very sore horse during the ride.
DrO
Member:
Mleeb

Posted on Thursday, Dec 7, 2006 - 9:35 am:

Dr. O, you've got two very interesting statements there.
1. "phenylbutazone (bute) as a cox inhibitor does not have any sedating effects" Is there any chance at all that it does? Maybe it is interacting with the components of the Fluid Flex I am feeding, and causing a sedative effect?
I have observed a noticeably sedated affect on 2 occassions in which he'd been given 2 gm of Bute. The first time, it was noticeable, but he was awake and alert whenever I asked him to do something. The second time was at a team penning event when we had long periods of standing still between our runs. During our wait periods, his nose was hanging down below his knees and he was very groggy, even during riding. This wasn't gradual, but happened the moment I parked him. Everyone thought it was hilarious. It was a long day, and I had given the Bute approximately 3 hours before his first run. At the very end of the day, it was like it was all wearing off, and he was more alert and less groggy. There was less delay in his responses, and a little more bounce in his step. Two weeks later, I experimented with a cattle drive with no Bute - he was very alert, energetic, somewhat bouncy, and very eager to get going -- no cow would run free! A much more enjoyable horse.
Also, I have a friend who trail rides and was just getting her horse back into riding this year after a long hiatus due to injury. She also noted that on the days when she gave him Bute prior to riding, he was extremely relaxed, and had none of the natural alertness to things like noises in the bush, birds flying up, that he usually did.
2. "By giving bute before exercise you might slow the progression of the arthritis..."
This is something I hadn't considered possible. Certainly, it could reduce or eliminate any potential soreness, but how might it slow the progression of the arthritis? Is it just by being in the system and preventing the inflammation that could come from exercise?
Moderator:
DrO

Posted on Friday, Dec 8, 2006 - 6:54 am:

1) When someone says "is it possible" there is always the chance of a idiosyncratic reaction but I consider this very unlikely. This is a drug similar to aspirin in humans.
2) Arthritis is an inflammatory disease: inflammation is what causes the joint to become more painful and less functional over time. Phenylbutazone does not block pain so much as lessen pain by controlling inflammation. By controlling inflammation the joint does not degrade as quickly.
DrO
Member:
Paul303

Posted on Saturday, Dec 9, 2006 - 1:56 am:

Is it possible, Michelle, that your horse and your friend's horse relaxed in reaction to the alleviation of pain?

It's so funny, because years ago, the man who took care of my horses (an ex-calf roper, bull rider now team penner at 78)hated to give my navicular QH mare the bute the vet prescribed daily because "she got crazy...she took nuts!!"

Perhaps different horses react in various ways to pain relief.
Member:
Mleeb

Posted on Saturday, Dec 9, 2006 - 10:02 pm:

You know, it certainly IS possible. In fact, this is what I thought the first time I noticed his laid back attitude. I had worried that I might get the high strung "man, do I feel good!" kind of horse, as did your friend. However, the second time this happened was at team penning, as I mentioned above, and effects were so very extreme. This made me think, hmmm, must be the bute, especially after having witnessed his earlier quietness, and after having heard my friend make similar remarks about her horse. The only other time I have ever seen a horse come close to looking this drugged was when I had the dentist in to work on a couple of them.
Anyway, as Dr. O thinks this is unlikely, I'm certainly open to other suggestions. Maybe just a lower dose of bute? I don't know if a topical application of an anti-inflammatory (can't think of the name of that darn stuff) would help in this situation, as the hoof wall conceals all the relevant joints.
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