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  Discussion on Tildren Study
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Member:
dwinans

Posted on Monday, Aug 20, 2007 - 2:55 pm:

Hi everybody!

My vet called me this morning and asked if I would be interested in participating in a Tildren trial. My horse has CHP/navicular. I've just started researching Tildren and was wondering if anybody had any knowledge of it.

I would be receiving diagnostic tests (exam, radiographs, MRI, and drug) which has a value of over $4,000 and I would be responsible for $500. It is possible that he would be given a placebo instead of the drug.

It sounds like a good deal but I'm a little nervous of the potential for harm during the test. I am awaiting a call from the vet and need to ask him some questions. I have been working very diligently to get him to where he is now and I would hate for him to go backwards with the pulling of shoes and such.

Any thoughts?
Member:
paul303

Posted on Tuesday, Aug 21, 2007 - 1:27 am:

Oh wow, Dawn, what a tough decision. I've been treating my mare's navicular since about 1986. She's 27 now, and I know the difficult balancing act of navicular. I know my first reaction would be excitement - followed by the same misgivings you've had.

Last spring, her right front seemed to be getting markedly worse. We needed to get her x-rayed ( we do so at regular intervals )which means removing the shoe. Her toes are rolled and she wears a rim/degree pad. The farrier removed the shoe one afternoon, and the vet was scheduled the following AM. The day after the vet, the farrier was scheduled to shoe. Well, the shoe came off on time, but after that, our plans came apart. My vet got hurt, I had some cardiac problems, and it took a week to get the x-rays. My farrier came right away to do the shoes, but it was too late. Although I couldn't get around too well, I managed to get an Old Mac boot on her with a slight wedge in the heel that I made from some styrofoam. But she went about 3 days with no shoe+wedge. In those 3 days, she bowed her tendon. It was inevitable, due to all the years with raised heels the tendon is slightly shortened, then the variable factor of the vet's and my health prolonging her shoeless period.....what a mess. The x-ray did show some roughening in the coffin bone and we had the joint injected - but it's hard to say how much it helped, as the bowed tendon right now precludes drawing any conclusions about the injection.

But, man oh man, the tests, exams, MRI, possibly the drug, that would tempt me. Your horse would be the beneficiary of quite a bit of medical expertise. What an opportunity! I wish I could help, but I would be just as uncertain as you are. Hopefully, your vet will be able to guide you through the decision process. Good luck, Dawn.
Moderator:
DrO

Posted on Tuesday, Aug 21, 2007 - 7:48 am:

Hello Dawn,
Not knowing the particulars it is impossible to judge and if problems are ongoing a exact diagnosis can be invaluable. Is your horse currently meeting your goals?
DrO
Member:
frances

Posted on Tuesday, Aug 21, 2007 - 10:29 am:

Dawn, when a friend's horse was diagnosed with navicular synDrOme a few months ago, I asked my (and her) vet what he thought of Tildren. His opinion was that while Tildren could prevent calcium loss in the navicular BEFORE it took place, once depletion had occurred and symptoms of lameness appeared, it was too late, and the only benefit was to the company's finances.

I have also read that administering Tildren, especially if it's given in one treatment, is a somewhat risky procedure.

Just some thoughts that come to mind ... good luck whatever you decide ...
Member:
dwinans

Posted on Tuesday, Aug 21, 2007 - 11:26 am:

I have received some answers from the vet doing the study.

It turns out that if he receives the placebo he will be given Tildren after the study is completed.

According to the vet there is a slight risk of mild colic 2-3 hours after the treatment (which is IV). They will have somebody sitting with him nonstop to watch for colic.

The lameness exam will be performed in the shoes he arrives in. He has to be a grade 2-3 lameness in order to qualify. Then the xrays have to show bone damage (which I know they will), then he will get an MRI. If the MRI shows extensive soft tissue damage he will not qualify because Tildren does not help soft tissues.

This horse has a 6 year history of intermittent lameness which has been "controlled" with shoeing. The xrays show bone damage to the coffin bone and navicular (I posted them in a different post a few months ago).

Once he has had the treatment I am to continue his work regime and shoeing as normal. Then he will go in every 2 weeks for the next 2 months for a lameness evaluation. They want everything status quo so that they can see if it's the drug causing the improvement (or not).

I have had him in a strict rehab program and he has progressed to jumping small jumps - staying sound so far. I have this rehab program down pat because I seem to do it every few years.

At this stage I do not think he will qualify at the 2-3 grade lameness. I have taken him off his meds (Isoxuprine and MSM) and in 14 days I will take him in for the exam. I know the effectiveness of Isoxuprine is debatable but maybe he will digress without it.

Currently he is happy, relaxed and rhythmic under saddle and jumping, although he points occasionally and trips A LOT on uneven, rocky ground.

I feel that although he is progressing well, his history shows that it will more than likely be temporary.

Lee, your experience is something that I have worried about. Each time he loses a 6 degree wedge shoe I grow about 10 more gray hairs worrying about his tendon. Very stressful!

I don't do a lot of showing (probably 2-3 shows a year if he's sound) and we don't jump high (3 ft at the highest) so I don't plan on pounding his feet hard but I would love to know what exactly is going on with his feet and if the drug would make him pain-free we would be much happier!

I am in a quandary but I don't need to make a decision right now. I'll reevaluate in 2 weeks and see where he is at that stage. It seems horrible that I want him to be unsound again! I'm going against everything that I have been working towards. Right now I'm trying to keep the attitude that if it's meant to be it will be.

Thank you for your input!
Dawn
Member:
pbauer

Posted on Tuesday, Aug 21, 2007 - 4:16 pm:

Dear Dawn,

This is related, but not the same...we enrolled our Doberman puppy in a prototype study...for Demodectic Mange. (This was some years ago...Paul and I had just gotten married) :-)

After he was diagnosed with Demodectic Mange...our veterinarian started him on a series of different products...oral and topical applications. Fair to say...that time was not on our side. He was losing so much hair...when I'd take him out for a short walk...some people would move to the other side of the street...he really looked terrible.

Our veterinarian (at the time) offered us the opportunity to enroll him in a study associated with the University of Illinois...we jumped at the chance.

With a lot of prayer and four overnight treatments...two weeks apart...he was cured!

Paul and I...at one point...thought he might have to be put down. Interestingly enough...my father was totally against it. He said.." Don't put that dog down...he might save your life one day." My father was absolutely correct!


Best Regards,
Tonya
Member:
stevens

Posted on Tuesday, Aug 21, 2007 - 4:50 pm:

Dawn,

Something to consider; if your horse stays "sound" when off his meds maybe he really is sound. If not, then it may be that the meds were just managing the pain and I'd jump at the chance for a free MRI.

Good Luck!
Member:
dwinans

Posted on Saturday, Aug 25, 2007 - 6:55 pm:

Hi there!

It looks like my decision has been made for me. Five days after being taken off the Isoxuprine and MSM he is lame. Nothing has changed other than that - he has had a light work week and he's not due for shoes until next Friday. I am pretty surprised at how quickly this came on. It might be a coincidence but I don't know.

I'm calling Monday to schedule his appointment.

Thanks everyone!
Member:
paul303

Posted on Sunday, Aug 26, 2007 - 12:09 am:

Best of luck, Dawn. If you can, please keep us informed. I'd be so grateful to hear how this turns out.
Moderator:
DrO

Posted on Sunday, Aug 26, 2007 - 9:14 am:

You are incorrect when you say nothing has changed Dawn. Many things change everyday, some observed, the work done and the feet growith, and some unobserved, like a misstep. Another change is that most causes of navicular synDrOme worsen over time. When dealing with the common chronic progressive diseases that come under the umbrella of navicular synDrOme such coincidences are common Dawn. I have always found navicular horses more prone to lameness as shoeing time approaches. However if you think the MSM Isoxsuprine is creating soundness, you should return the horse to it. I would look for improvement following the next good trim and shoeing.
DrO
Member:
dwinans

Posted on Sunday, Aug 26, 2007 - 2:26 pm:

Dr O, I have read your article regarding Isoxuprine and have always been skeptical of its effectiveness - contrary to the majority opinion that surrounds me.

After being grade 2 lame yesterday he was sound on soft ground today.

I am going to assume that he will be grade 2 lame at the exam in 9 days.

Your words "chronic progressive diseases" make me even more determined that he needs to be part of this study. I would love to discover exactly what is going on in those feet!

Thanks for your response.
Member:
dwinans

Posted on Thursday, Oct 4, 2007 - 5:47 pm:

Hi everyone!

I just wanted to report an update on Remy's participation in the Tildren study.

He "passed" the lameness exam and radiographs and is now getting an MRI. Yippee! As long as the MRI does not show extensive soft tissue damage he will be receiving the treatment.

I have noticed absolutely no difference in his symptoms since he has been off his meds for the past 7 weeks. He is both off and on sound depending on the shoeing cycle.

Also, of interest is that he seems completely sound when riding in the arena and I have been jumping him without any hint of lameness yet he qualified as grade 2 lame in the exam. Maybe he is more stoic than I thought, poor guy.

Thanks for your interest.
Member:
pbauer

Posted on Thursday, Oct 4, 2007 - 7:35 pm:

Dear Dawn,

Great News!!



For the wonderful update!

My Best,
Tonya
Member:
paul303

Posted on Thursday, Oct 4, 2007 - 10:41 pm:

Thanks so much, Dawn, for keeping the reports coming.

Wishing you the best,

Lee
Member:
dwinans

Posted on Tuesday, Oct 16, 2007 - 2:20 pm:

Hi everyone!

I just heard from the vet and Remy qualified at the MRI. He said the MRI shows no soft tissue damage - just navicular bone inflammation. He goes down for the treatment next week.

I am required to keep a daily journal and will take him down for a checkup every 2 weeks for the next 2 months.

Finger's crossed this improves things!
Member:
stevens

Posted on Tuesday, Oct 16, 2007 - 3:27 pm:

Great news, not having soft tissue damage.

Good luck with the treatment.

Chris
Member:
canter

Posted on Tuesday, Oct 16, 2007 - 4:09 pm:

My fingers are crossed for you and Remy, Dawn. Best of luck!
Moderator:
DrO

Posted on Wednesday, Oct 17, 2007 - 6:07 am:

Dawn that is great news on no soft tissue damage and really helps the prognosis. What are the chances of getting the MRI images posted along with the explanation of the changes that indicate inflammation?
DrO
Member:
dwinans

Posted on Wednesday, Oct 17, 2007 - 11:28 am:

Hi Dr O!

I will pick up the disc when I take him to the clinic on Monday and post it on Tuesday hopefully.

I'm happy to hear that it helps with the prognosis.

Thanks for your response!
Dawn
Member:
dwinans

Posted on Friday, Dec 21, 2007 - 12:27 pm:

Hi all!

I wanted to give everybody an update on the Tildren study that Remy participated in. The study wrapped up on Tuesday and I found out yesterday that he had received the drug and not the placebo.

To say that the drug was effective is an understatement. At his first checkup (2 weeks after the treatment) his lameness exam went from a 2 on both front feet to an "almost 1" on the LF. He continued that way in each exam - including at the end of his shoeing cycle.

At home there is no more tripping, pinning ears, or "ouchiness". I am actually having to learn to ride him again because he is a different horse. I used to have to kick him to make him go forward but now I can't keep him slow. It's amazing!

Now he is enrolled in an open 6 month study during which he gets the drug once every 3 months and gets check ups once per month. The cost is included in the study and it's definitely worth the inconvenience of hauling him 45 minutes away.

I know the drug is expensive but after seeing the results I will save my pennies and get it done when he needs it.

Cheers!
Member:
scooter

Posted on Friday, Dec 21, 2007 - 2:47 pm:

Great dawn! This will help many us. Glad your boy is "feelin his oats"
Member:
canter

Posted on Friday, Dec 21, 2007 - 5:03 pm:

Thanks for the update, Dawn & so glad your horse is feeling better. Please continue to keep us posted.
Member:
stevens

Posted on Friday, Dec 21, 2007 - 5:22 pm:

Fantastic news Dawn. I hope he continues to improve.

Chris
Member:
pbauer

Posted on Friday, Dec 21, 2007 - 8:50 pm:

Dear Dawn,


******EXTRAORDINARY*****

Member:
paul303

Posted on Saturday, Dec 22, 2007 - 1:56 am:

HA!!!! No, I mean HO,HO,HO!!! I'm lovin' this. Diane: can you continue to update? I'd love to know how this goes.
Member:
ilona

Posted on Saturday, Dec 22, 2007 - 8:45 am:

Dawn,
That is very good news. Remy is such a beautiful horse and now you will be an even greater surprise winner at the shows you compete in! Going to the next level now?
Moderator:
DrO

Posted on Saturday, Dec 22, 2007 - 10:23 am:

Let's slow down Dawn,
your conclusion that the tildren is effective is premature. You horse received treatment and he got better, but this is not proof of a relation between the medicine and the healing. For that we will need to wait to see how the treatment group compares with the control group. I note that Remy prior to beginning the project had a history of intermittent problems, maybe this is one of those good times. I don't mean to bring you down Dawn, but you need to understand that there is still several steps to be taken still: organize the data, compare the controls with the treated horses, and analyze the significance of the results. Only then do we have a shot at making a judgement.
DrO
Member:
ilona

Posted on Sunday, Dec 23, 2007 - 2:50 am:

Ahhhh, Dr. O the voice of reason. Keep us posted Dawn.
Member:
dwinans

Posted on Monday, Dec 24, 2007 - 10:50 am:

Yes, I guess I jumped the gun saying that Tildren is effective. I wanted to give my personal experience to date thus far. If this is a "good time" and it is temporary I will report it when it ends.
New Member:
goldshoe

Posted on Sunday, Mar 16, 2008 - 2:50 pm:

Hi Dawn,

This is a few months after the fact, but I am very curious if you had to use a different farrier while your horse was in the study. My horse just "qualified" for the tildren study too. I most likely will just bite the bullet and pay for the medication instead of trailering him back and forth, due to his ulcers and the cost of fuel etc. But first I am doing as much research as possible on the side effects of the medication and getting feedback from other people who have used tildren. I am wondering how your horse is doing.
Member:
dwinans

Posted on Monday, Mar 17, 2008 - 2:28 pm:

Hi Melanieca,

Yes, I am required to use the clinic's farrier when he goes in for his 4 week check-up. The good news is that the study pays for the front shoes. When he was first shod there I explained that I had had good luck making him feel comfortable in the "unusual" shoes that he was in and that I wanted to continue the same shoes. Fortunately, the farrier and vet agreed and he has done a great job shoeing him.

I understand why you may want to pay for the treatment instead of participating in the study. All I can say is that the monthly check-ups and repeated treatments (every 60 days) for just the cost of fuel and inconvenience has been worth it. It sure is a pain though.

As far as how Remy is doing: he continues to be 100% sound. In fact, he trotted 100% on pavement in his last checkup.

I asked my vet how long the effects of the treatment is supposed to last and he said that the Europeans think that it is permanent but the Americans are a little more skeptical. The drug stays in their system for 60 days - that is why this 2nd phase of the study gives the treatment every 60 days.

I have not seen any side effects, although with each treatment he spends a minimum of 4 hours at the clinic with the staff keeping a close eye on him for signs of colic.

I hope I answered your questions. Good luck with your horse!

Regards,
Dawn
New Member:
goldshoe

Posted on Monday, Mar 17, 2008 - 5:27 pm:

Hi Dawn

thanks for the update and the information. The fact that your horse remains sound is wonderful. Is this jogging a straight line on pavement or do they lunge a small circle as well? Are you continuing to jump him? I have had my horse shod in those "unusual" shoes for three years. They are, in my opinion, one of the reasons he has been rideable, not to mention his ever improving show record. What does your horse wear for shoes anyway?

thanks again
melanie
Member:
dwinans

Posted on Monday, Mar 17, 2008 - 5:40 pm:

Melanie,

They jog him both in a straight line and in small circles. Yes, I jump him once or twice per week and hack the other days (with one day off). Frankly, his rides are very light with the jumping very small. Very rarely do I do a full course - it's usually just trotting crossrails and a couple 2'3" lines here and there.

He has 4 degree wedge pads on. I used to think that my goal was to get him out of them but after years I have come to the conclusion that these will probably be on for life. It's not that he has bad feet per se it's that his pastern angle is so bad that we have to correct it with wedges.

Surprising, now that he is feeling better he moves pretty good in spite of the big, heavy shoes. He is really swinging his shoulder and striding out. People are always commenting on how good he looks. And he attitude is much improved - no pinning ears, grinding teeth, and swishing tail.
Member:
paul303

Posted on Monday, Mar 17, 2008 - 10:06 pm:

Dawn, Thank you for the update. I was wondering: will there be any followup tests? If there are, will you let us know the results?

Wishing you continued fantastic results...

Lee
Member:
wgillmor

Posted on Tuesday, Aug 19, 2008 - 5:50 pm:

Hi Dawn,

I'm wondering if you have any further update for us. Has the study been published or do you know if the investigators found significant results?

Thanks,
Wiley
Member:
dwinans

Posted on Tuesday, Aug 19, 2008 - 6:57 pm:

Hi there!

Thanks for your inquiry!

I have completed the study but I believe the study is still ongoing. I don't know when the anticipated publication date is. I need to ask my vet.

My horse continues to be sound - whether it was from the drug or from the shoeing every 4 weeks remains to be seen.

I am now responsible for paying for the shoes ($180) so I'm going to try to make the intervals every 6 weeks. Hopefully, that won't change anything.

I would love to get some radiographs done just to see if any changes can be seen on them. Would love to have an MRI but the cost is considerable.

Thanks again for asking!
Dawn
Member:
paul303

Posted on Wednesday, Aug 20, 2008 - 9:28 pm:

Thanks, Dawn, it's good to hear about the continued soundness...my navicular mare has been shod every 4 to 6 weeks for 20 years now and the shoeing has kept her comfortable....until a few days before she's due for shoes again. But by "comfortable", I don't mean sound.

If you can find anything out from your vet about when the study will be published, I'd love to hear.

Thanks for your information...it's much appreciated.
New Member:
conti900

Posted on Friday, May 1, 2009 - 12:53 am:

Dawn - I am so excited to hear about your success with Tildren. We are ordering it for my mare who has been down for about 6 weeks already with a bad bone bruise in conjunction with some cartilage deterioration. The vet seems hopeful, but I read online that it may take up to 8 weeks to receive the drug from Europe. (hoping that is not the case)

I currently have my mare on OCD pellets as a dietary supplement and she had her first IRAP treatment on Tuesday. Thank you so much for sharing your experience. I hope all continues to go well and that you will keep us all posted on your horse's progress. - Cory
Member:
dwinans

Posted on Friday, May 1, 2009 - 1:28 am:

Cory,

Thanks for your post.

I feel very fortunate that my horse continues to be sound since receiving the Tildren treatments.

It is my understanding that it stops the remodelling of bone. I have read that it has been used to treat ringbone in addition to navicular which makes since as they are both bone problems. I have not heard that it is used to treat bone bruises or cartilage.

Good luck with your mare.
Member:
leslie1

Posted on Sunday, Jun 21, 2009 - 6:33 pm:

Dawn
Hows your horse doing? I hope he is well! Has he been sound for a year now? Is he in a bar type shoe or regular with wedge/pads? My mare was recently diagnosed with CHPS and so I have read this thread repeatedly. Have you heard anything about the tildren getting passed by FDA(?)
THanks
L
Member:
dwinans

Posted on Sunday, Jun 21, 2009 - 11:18 pm:

Hi Leslie,

Very cute photo on your profile!

Yes, Remy has been sound for over a year now (other than being side-lined for several weeks with a quarter crack). It's hard to believe. I have recently started a more intensive work program and have a hunter/jumper show at the end of July that we're working toward.

He is still in the originally prescribed egg bar and wedge pads. I have come to accept that he will always need them.

I don't know how much longer he will continue to be sound and am always on the lookout for signs of pain. It's so hard to tell with him because he is not obviously head-bobbing lame. It's more of an attitude thing which I have learned to recognize because I've known him for so many years.

As far as I know Tildren has not been approved yet. I have heard of other success stories here in my area as there is one vet who is administering it as not part of the study.

Are you considering Tildren for your mare?
Member:
leslie1

Posted on Monday, Jun 22, 2009 - 10:22 am:

Hi Dawn
Im not sure. My mare is only lame in her right foot. That makes me think soft tissue. She was at a trainers at the time and the vet didnt do xrays. just nerve block and gave a very vague diagnosis of CHPS. When I got the vet bill, I found out he didnt even do PDN block --it said Abaxial nerve block?? which I think is the whole foot from pastern down. I have her home now and resting. I will end up having a different vet out and make sure to get xrays this time and a PDN or coffin block! If it is the nav bone, I would love to get the tildren...if its affordable.
That is such wonderful news about Remy. Good luck at your show and please post pictures!
Thanks
Leslie
LOL I found that profile pic on the internet and thought it was the cutest thing. Its like "What are you??!!"
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