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  Discussion on Giving Tildren a try
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Member:
lynnland

Posted on Wednesday, Apr 6, 2011 - 11:54 am:

OK, I'm going to give Tildren a try on my horse that was diagnosed with navicular (https://www.horseadvice.com/horse/messages/4/355130.html). I realize he is a poor candidate (because of soft tissue damage) but the rate of bone deterioration is high and we don't know to what degree that is, or is not, causing the pain and soft tissue issues. My local vet had never heard of the stuff and is only willing to do this because it was recommended to me as a treatment option by the two large clinics in Ontario that do horse MRIs. She does not want to do the one time infusion but another method described to me (other than the 10 day treatment) was to give 2 doses once per day for 5 days. Hoping she will go with that as the call out charge is expensive and would run $500 for 10 days (although I will be splitting it with someone else that is going to try this). The intent is to have radiographs taken again in ~ 12 months. I don't expect miracles here but given that he is only 7 it is likely worth a try.
Moderator:
DrO

Posted on Friday, Apr 8, 2011 - 7:20 am:

Good luck Lynn and keep us up to date with your horse's progress. I have copy and pasted the nature of the bony changes from the earlier discussion so others can see how this may apply to their horses:

On February 17, Peety was placed under general anesthesia & an MRI
examination of both front feet & pasterns was performed.
In the right-front foot, there were 3 abnormal findings: 1) The channels
(synovial fossa) within the navicular bone were obviously enlarged. 2) There
was remodeling in the impar ligament of the navicular bone & in the adjacent
deep digital-flexor tendon close to the attachment (insertion) of each of
these structures on the coffin bone (P3). These changes were consistent with
adhesions (scar tissue) between the impar ligament & deep digital flexor
tendon approximately 1 cm below (distal to) the navicular bone. 3) There
were mild irregularities in the lining of the navicular bursa just above
(proximal to) the navicular bone, with several small localized areas of
irregularity (fibrillation) on the adjacent front (dorsal) surface of the
deep-digital flexor tendon.

In the left-front foot, there was 1 abnormal finding: A large localized area
of altered density

A subsequent x-ray examination (navicular series) of both front feet was
performed. There was a moderate increase in the size & number of channels
(synovial fossae) in the lower (distal) border of the navicular bone in both
front feet, but more severe in the right-front foot. In the left-front foot,
there was a suspect area of increased density (sclerosis) in the lateral
aspect of the navicular-bone medullary cavity, best seen on the
skyline/caudal-tangential view. This x-ray study was also compared to
several x-rays of the front feet that were performed during the prepurchase
examination in 2008. There appears to have been a significant increase in
the size & number of synovial fossae within the navicular bone in each foot.
DrO
Member:
lynnland

Posted on Friday, Apr 8, 2011 - 8:03 am:

Thanks Dr. O. for adding that stuff in here.
Member:
lynnland

Posted on Friday, Apr 8, 2011 - 8:14 am:

I guess for anyone new I should add that the horse is a grade 4 lame, barefoot, and currently turnout daily by himself in a field adjacent to other horses. The history of the horse's lameness can be found under the following post: https://www.horseadvice.com/horse/messages/4/355130.html
Member:
paul303

Posted on Saturday, Apr 9, 2011 - 1:06 am:

Thank you for allowing us to follow, Lynn. It's been a long hard road, hasn't it?

I have a navicular mare that was diagnosed in 1986. She had been on her way to a reining career before that. I've been lucky enough to have wonderful farriers over the years, that kept her sound into the nineties for pleasure showing. After that, we retired her from the show ring, but still trail rode her until about 3 years ago. She's fully retired now, but still sports her rim pads, raised heel and rockered toe that is replaced every 5 to 6 weeks. This is the combination that has kept her comfortable since around 1998, when we gave up trying every "new" idea and theory that came down the road.

She was on almost daily bute for about 20 years and now takes previcox. Her main problem now, is stiffness in her RR stifel from an upward fixation problem in the eighties...and her Cushings which we started treating in 2005.

So, there is life after navicular. It may not be the life you planned for originally, but it's very possible that you can manage to have a reasonably sound horse.....but not for jumping. Just as I was unable to have a reiner.

I'm anxious to know how the Tildren works out. I know that it's too late for my mare, but over the years I've dealt with navicular, my curiosity is killing me. I really want to know how this turns out. Thanks again
Member:
lynnland

Posted on Saturday, Apr 9, 2011 - 8:33 pm:

Thanks for the story Lee. Unfortunately, we haven't managed to get him back to the stage where he is sound at a walk (not under saddle). Right about now, that would make me pretty happy. I'll chat with our farriers about putting shoes on him, although he was obviously much more comfortable without them when this all started.
Member:
lynnland

Posted on Tuesday, Apr 26, 2011 - 9:19 am:

Hi Gang,

Just a quick update. We went with the double dose daily for 5 days (=0.2 mg/kg/day). My horse was weighed in February at 1250 lb (570kg). We also treated a friend's smaller quarter horse. Today is day 5 and the two horses have done well. My horse showed no reaction other than a significant DrOp in his water consumption on day 1 (which picked right back up the next day). The other horse we are trying this drug on showed a sudden jump in respiration rate when we did the first injection. It resolved in about 5 minutes and all was well after that. This little guy has an automatic watering bowl so can't say whether his water intake changed.
Member:
lynnland

Posted on Wednesday, May 11, 2011 - 7:48 am:

Hi Gang,

Just thought you might be interested in what the round of Tildren cost me. The drug itself was $675 and 5 days paying half call-out charge for the vet was $125, which comes to $800. Add in the taxes (a whopping 13%) and you get ~ $900. Not as bad as I had feared.

Cheers
Member:
paul303

Posted on Friday, May 13, 2011 - 12:27 am:

Many thanks for the update. Could you please continue to comment on any changes (hopefully improvements)in gait, movement, head bob....you know, all the characteristic navicular signs.

If you ever decide to shoe, be very watchful of bar, or heart bar shoes. They are commonly recommended in navicular, and they were awful on my mare. I have two friends with navicular horses who had the same experience. My current farrier does not look kindly on them either.

My mare sports an obviously rolled toe, and her "rim" degree pads span the frog in the heel area. Most of the time, she gets equipak over her soles. This is left out a few times a year to give her soles a chance to be exposed. This mirrors a technique that her (brilliant)farrier back in the eighties used, that kept her in good enough shape to show. Back then, he cut her full leather pads to fit with raised heels and packed her with his own recipe of oakum. The frequent trimming or shoeing, whatever you do, seems to be a large percentage of improvement in a navicular horse's life. The easing of the breakover is also extremely important.

I'm really anxious to learn if Tildren holds possibilities......another mare of mine has shown some "changes" in her right front. As for my old mare...she turned 31 on May 2. I remember that night, back in 1980 when I stepped quietly into the stall and pulled the membrane back from her head at around 1:30AM. I sat in the stall until 5:00AM and then went home, got a shower and went to work. Sleep was not a high priority back then.....
Member:
lynnland

Posted on Friday, May 13, 2011 - 8:11 am:

Hi Lee,

I don't actually expect to see anything from the Tildren on my horse given the very sudden and severe lameness that has mostly been attributed to ligament and tendon stuff. However, it might help if we can get some soft tissue healing. I hope it will help out the other little horse (QH) we tried it on. My horse is still very lame. He is lame at the walk although the average grandma off the street might not notice it immediately. I am out of town next week and the horse needs trimming so my plan is to have him trimmed today then wait a few weeks and try the shoes. I was just planning on a degree pad for the heels and a roll or rocker (need to discuss with my farrier). Why the pad over the frog and the equipak?

Thanks again
Member:
paul303

Posted on Saturday, May 14, 2011 - 1:09 am:

The rim (degree) pad is cut out in the center and has about an inch wide "bar" left over the widest part of the frog. This results in stimulation to the frog during hoof movement which is lost when the heels are raised. There was a time when she wore just rim degree pads cut to the shape of the shoe. With the heels raised, and little to no ground contact with the frog, the frog began to shrink. We went through the bar shoes after that, but they prevent all normal hoof expansion and contraction during movement and her heels started to contract - she also exhibited marked discomfort in these shoes. These two techniques hampered nature's intended stimulation throughout the hoof. The cut out degree pads she has now give her added support while raising her heels and massaging her frog.

We began the equipak for two reasons: 1. In winter, the snowballs in her feet were terrible and constant. They changed her angles and made her unstable enough to cause her a lot of navicular pain. I could only clean her feet twice a day and it wasn't enough...and you CAN'T lock a navicular horse in and not let them move around. Equipak=no snowballs.
2. The bar across the frog can make the sulcus by the frog difficult to clean. My farrier fills both the sole and this area with equipak and I don't have to clean the shod feet at all. My mare has never lost the equipak between shoeings.

My own impression of the equipak is that it must be like wearing a gel sole in your shoe. I also use it on an extremely flat footed mare I have. She is shod in the front and before the the equipak, could only be ridden on soft grass, sand or good arena footing. As I said, there are certain times of the year we leave the equipak out just to watch the whole sole.

Just in case you're wondering, I've had relatively few issues with thrush over the years, but with the equipak, I've had none. That was always my biggest fear. Both my mares are much more comfortable with the equipak than without.
Member:
lynnland

Posted on Wednesday, Jul 13, 2011 - 11:36 am:

Just and update. Unfortunately neither horse has shown any improvement with the Tildren. Not really a big surprise as my horse had a significant amount of soft tissue damage and the other horse had initially presented similar to my horse (sudden onset with extreme lameness) but that owner did not have the benefit of MRI results like I did.

Lynn
Member:
paul303

Posted on Wednesday, Jul 13, 2011 - 10:14 pm:

Rats...was hoping for something. Best of luck, Lynn, as you deal with this problem. It's a frustrating and disappointing thing to live with. Thanks so much for getting back.
Member:
lynnland

Posted on Thursday, Jul 14, 2011 - 7:24 am:

Hi Lee,

It sounds like the Tildren trials intentionally avoided horses with soft tissue damage so maybe it might work for those horses that develop it in the more typical fashion (i.e., slight on off bilateral lameness at an older age). We'll have to see what the outcome of the trials are.
Member:
lynnland

Posted on Monday, Aug 29, 2011 - 8:55 am:

Hi Dr. O (and all the rest!),

After about 6 months my horse appears sound at the walk. We put front shoes on him about 4 weeks ago and he showed significant improvement. We did not put on wedges as his feet had cracked up in the dry weather and my farrier was worried about how little foot he had to work with. He trots and canters in the paddock with his friends but I haven't put him on the lunge to see if he is sound at these gaits. The concern I have is that he still points the foot, although no nearly as bad as before and is no longer lifting the foot off the ground when standing on the interlocking stone aisleway. The vet suggested that he might be pointing because the soft tissues can heal a bit tight after him resting that foot so much...or the tissues may not be healed. Another MRI is simply out of the question (the 14 hour round trip is nuts for a lame horse !). So, I am hesitant to add wedges if he is doing better in normal shoes but...any thoughts on the pointing? I still have no idea what I am going to do with him as we don't expect him to actually be able to do anything other than walk around under saddle.

Thanks

Lynn
Moderator:
DrO

Posted on Tuesday, Aug 30, 2011 - 6:59 pm:

Hello Lynn,
with no evident lameness I am uncertain as to the significance of the pointing and would not use it as a indication of needing other treatment. Decisions on using wedges should be based on ap balance of the foot.
DrO
Member:
paul303

Posted on Thursday, Sep 1, 2011 - 1:20 am:

I always saw the pointing whenever my mare's shoeing schedule had to be extended. The tiniest bit of extra growth would cause that right front to shoot right out. Once shod, the pointing stopped immediately.
Member:
lynnland

Posted on Thursday, Sep 1, 2011 - 7:06 am:

Thanks Lee,

Interesting. I don't think my horse is showing that same pattern but will keep my eyes open. Was she sore during those times when she was pointing? Although I suppose if she was noticeably sore or not it appears she was uncomfortable enough to chance her stance.

Thanks again

Lynn
Member:
paul303

Posted on Monday, Sep 5, 2011 - 1:22 am:

Yeah, she was sore. I'd like to add, that, luckily, for the past few years, her schedule has been perfect and no pointing has occurred. It's almost odd, not ever seeing that RF stabbing out ahead. Along with it, is the absence of floppy/pinned ears...which must have indicated pain for many years.
Member:
lynnland

Posted on Sunday, Oct 23, 2011 - 9:28 pm:

Another update and a few questions. Rode him at the walk for a short distance a few times per week. Was great for 4 weeks then I went away for work for a week and came back to a very lame horse. We put 2 degree wedges on. He hasn't show any improvement after 3 weeks. Just wondering how long you would expect it to take to see an improvement, if there is going to be one.
thanks
Moderator:
DrO

Posted on Tuesday, Oct 25, 2011 - 8:57 pm:

When using wedges I don't think in terms of time to improvement, I usually think in terms of proper ap balance: is the foot better balanced now? If you running an experiment I would give it at least one shoeing cycle.
DrO
Member:
paul303

Posted on Saturday, Oct 29, 2011 - 1:04 am:

Dr.O is right. Have patience. It's so, so much about the balance in the hoof and the proper alignment of the bones in the leg when that balance is achieved. It took us about 5 years to get everything pretty well set. Back then, we took X-rays about every three years to check how things were progressing. You might not be in perfect (for your horse)balance yet. Keep your farrier well informed about foot pointing and head bobbing. When we got things straight for my mare, (took a few years)she improved immediately after shoeing and went well for about 3 to 4 weeks. After that, the foot pointing would start, and the head bobbing at the trot, and the reluctance to turn to the right would begin.

I'll say one thing, here. Up until 1998, she was kept on rocky mountainous ground. In 1998, we moved to an area that is flat and sandy. Her improvement that was very noticeable. My mare had been on daily bute and we were able to slowly decrease it. Unfortunately, after three years on a 5 week shoeing schedule and flat sandy ground, she bowed a tendon at 21 years old - screwing around in her pasture going nutso because she felt so good.

So, just take it slow. You'll need to work this out and find out just what works for your horse. It just takes awhile sometimes to get things right. One other thing that I've noticed over the years - when my mare was confined - due to weather or illness - her navicular did not do well. A decrease in exercise or movement seems to affect her.

Best of luck, Lynn
Member:
mare1

Posted on Thursday, Feb 2, 2012 - 10:41 am:

Has anyone had any recent good experiences with using Tildren?
Member:
digger89

Posted on Thursday, Feb 2, 2012 - 3:18 pm:

I used Tildren on my paint horse. When he developed heel pain he had an MRI right away. He showed changes in the navicular bones in both feet with little soft tissue damage. A follow up MRI one year later showed the bones had not changed since Tildren administration. Unfortunately the soft tissue degeneration had greatly increased in spite of aggressive treatment (shoes, pads, IRAP, shock wave therapy, steroids, previcox, etc) so sadly he had to be euthanized (he was not even pasture sound. So no, Tildren did not help overall, but it did stablize the bone degeneration and spur formation. Sarah
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