Lameness in the Performance Horse
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Lameness in the Performance Horse

August 11, 2019

[MUSIC] [Amanda Bodle] Okay, good evening
everyone and thank you for your patience while we prepared. Welcome to the My Horse University and eXtension
HorseQuest live webcast titled ‘Lameness in the Performance Horse’. This webcast continues our Horse Health series
which will include two more webcasts on important health topics. Our presenter tonight is Dr. Ann Rashmir,
Associate Professor at Michigan State University’s College of Veterinary Medicine. Dr. Rashmir earned her DVM from the University
of California, Davis and is a Diplomat of the American College of Veterinary Surgeons. She was an assistant professor in veterinary
molecular biology at Montana State University for three years and then worked for fifteen
years as an associate professor in equine surgery and medicine at Mississippi State
University. She joined the Michigan State University’s
College of Veterinary Medicine in 2009 where she studies equine skin diseases and also
has an interest in orthopedics. Please note that you’re able to ask questions
during the presentation using the text chat to the left hand side of your screen. Our questions will be facilitated by Narelle
Stubbs, a visiting research associate at MSU’s College of Veterinary Medicine. She is a physiotherapist and will receive
her PhD at the University of Queensland in Australia. Our presentation is going to be recorded and
uploaded to our website if you want to review it at a later date. And at this time, I’ll turn the presentation
over so we can get started. [Dr. Ann Rashmir] Thank you, Amanda. And thank you all for coming. I did want to talk to you about lameness for
a couple of reason. One is, it is the number one cause of economic
loss according to the National Animal Health Monitoring System’s study. As you can see as you go down here, that nine
to fourteen events occur per one hundred horses with about four hundred and thirty two dollars
per event occurring. It’s got a small case fatality rate relatively,
but here’s where we can really make an impact on lameness – with this one hundred ten days
lost per event. So a lameness in a horse generally average
one hundred and ten days lost to performance. As a comparison you can see colic is less
common with four events per one hundred horses and less expensive, traditionally – frequently
one dose of Banamine sort of cure at about one hundred and sixty dollars per event, but
a much higher case fatality rate. Now here’s another big difference too is that
there are only two point four days lost per event. So if a horse colics, there’s not a whole
lot in the way of losses as long as the horse recovers. Not a whole lot in the way of losses in training
or performance, but certainly if the horse is lame, it does cost quite considerably in
time out of the sport. So this is the plan for this afternoon’s lecture. First, we’re going to cover a little bit about
prevention of lameness including conditioning, and there’s a very large component to conditioning
that we don’t have to cover that today but I do want to make a few comments about it. Nutrition, again, a very large component of
performance nutrition. And there is an entire My Horse University
subject area on nutrition which I would encourage you to see. Shoeing is critical as well and saddle fit
and shoeing are two things I am going to cover a little bit more extensively. And then for the bulk of the lecture we’re
going to talk about lameness evaluation including nerve blocks and joint blocks, radiographs
or x-rays, ultrasound, bone scan, MRI, a little bit of gait analysis because we happen to
have a very good system here at Michigan State University with Dr. Hilary Clayton, and a
little bit about thermography mostly with saddle fit in thermography, but it is used
also for the diagnosis of lameness. And then for treatment choices, we’re really
going to focus a little bit on what’s new, things you may or may not have heard of and
that would include IRAP, stem cells, platelet rich plasma, Tildren which is not available
in this country but your veterinarian can get it actually legally. And then I do want to emphasize the importance
of rehabilitation and physical therapy. And Narelle will be speaking about that for
an entire hour in about a week. So I’m not going to dwell on that at all. I did want to cover a few things about some
of the oldies but goodies, the drugs that you commonly are using right now – the Bute,
the Banamine, Ketofen, Cosequin, Adequan, Hyaluronic acid and maybe a little bit of
shock wave if we have time. So first, as far as prevention of lameness
– certainly, picking your horse carefully will go a long ways towards getting a horse
that performs for you for a good length of time, it performs well for you. I highly recommend a pre-purchase exam on
any horse you’re going to purchase and the horse should actually have some of the very
standard things that we think about for a good horse: good conformation, a personality
and ability suited for its intended use. You know, the horse that has to spend an hour
in the loping pen before you can count on it is not a horse that’s going to actually
hold up to use as long as a horse that can lope for about fifteen minutes or ten minutes
to warm up. I also would recommend at the pre-purchase
examination banking blood. What this does is it – you actually have your
veterinarian take blood from the horse and actually separate it out and freezing important
components for evaluation of drugs. And so if the horse were to turn up lame days
to weeks and sometimes even a month or so later, you can actually go back and run that
blood and have it analyzed to see if the horse was drugged at the time of pre-purchase. And I do encourage that in all pre-purchase
examinations. Conditioning is a critical part of prevention
of lameness. We aren’t going to spend a whole lot of time
speaking about it, I know Narelle is going to speak about it as well. But it is critical. As is the riding surface. Certainly, horses that actually have access
to better riding surfaces do last longer and do perform better. Riding surfaces that can be manipulated with
either tractors or whatever to keep them comfortable for the horse, definitely encourage you to
do that because it will make a difference in the long term for your horse and frequently
also in the short term. The amount and type of riding schedule is
important as well as far conditioning goes but also we know that there are some things
that are more problematic for the horse in the long run. There horses that get ridden every day or
regularly certainly do better than the horses that tend to be sort of weekend warriors where
they go out and be ridden quite extensively on the weekends and then put in a stall and
rested the rest of the time. I do want to kind of mention something here
with this ‘forget the “one last time”.’ There are quite a few in my career of looking
at lame horses, twenty something years of it, where I’ve had clients come to me and
say, ‘You know, the horse was doing really well and I knew the horse was tired and I
was tired and the trainer asked for just one more time.’ And that would be either one more time around
the jumps, one more time around the barrels, one more cow to cut, or steer to cut – whatever. And that was the time that the horse actually
really had more than it could take and that’s where the lameness frequently originated. It is something to keep in mind when both
you and the horse are fatigued, it’s a good time to quit and not go just that one extra
moment where you’re more likely to get hurt. And that’s true of any athlete in any sport. And remember that you’re in control, it’s
your horse’s destiny that you’re in control of, and if your trainer wants you to do one
more but you know the horse is already beat, I would encourage you to actually stand up
for your horse. Nutrition, moving along, is critical to the
horse’s performance and certainly know that feeding oats and grass hay is certainly not
something that a horse can long term perform on anyway. There’s a whole, as we said, a whole area
for nutrition in My Horse University and I would encourage you to look at that. And farriery is the next thing that we are
going to actually jump in to and have a look at first because it is critical to the performance
of your horse. So I got these photos and this demonstration
from Dr. Tia Nelson, she’s a veterinarian and a farrier and one of my favorite farriers
in the world actually. And I think she does a very nice job of showing
with these photos exactly what needs to be done on these horses that typically performance
horses – typically because part of the way they’re housed tend to grow this long toe
and a low heel. We need to get a farrier that is consistently
able to address this problem because it is such a common problem in performance horses. So just to show you this long toe and low
heel. and then as you can see here, she’s got it marked where the toe needs to come
off from not just the bottom to shorten the toe because that will actually get into soft
tissues and sensitive tissues if you just try to take from the bottom. It also has to come off from this dorsal surface
of the hoof. And you can see this horse, same horse as
here with the hoof appropriately prepared. I’m going to show you the same horse and the
same hoof from the underside of the horse’s foot. So here is the overgrown foot, you can see
the heels are – quite a bit of difference here where the angle of the hoof is. What we’re going to do is actually move that
back so that the horse’s center of balance is moved back as well. So we’ll actually start our cuts right here
and what that will do is it will actually give us a much wider surface area for the
horse to stand on and move the center of balance back on his foot which makes a lot more comfortable
for his tendons and his navicular bone. And actually the rest of his joints going
up the leg as well. So this is a very nice prepared foot compared
to what it was. So, what do you think about this horse’s feet? This is a horse that had a long toe and a
low heel and so the horse has now got elevation to his heel. Is that actually addressing the problem? And I think you can see just even from the
shape of the horse’s foot and the lines that are going down, this horse – this is a horse
whose feet are very uncomfortable and its hoof is growing oddly in response to that
abnormal force on it. So what’s better to do with these guys is
instead of having this kind of propped up sort of toe, instead of a high heel a toe
heel. What we’re going to do is actually change
this so the horse actually has a better weight bearing surface and he’s a lot more comfortable
and his foot will actually grow better in response to the better shoeing and better
trimming. So here he is standing up and here he is with
the original shoe on. I think you can see his foot is way far in
front of his heels now. And that’s bad for center of balance which
should be back here. Also, his heel of the shoe is actually pinching
in on his frog which is very uncomfortable for horses. And the frog actually will – well, with the
shoe by the frog is actually too tight, it’s not allowing for expansion. And so here is the same horse with the shoe
off. Here are the areas where we are going to start
our cutting. Here is where we want to move the center of
balance back to. And this is the end result. So you can actually see now that this little
area here, and the horse has got a not to well prepared foot – is not nearly as large
as this area in the well prepared foot. Plus, the toe is way far forward on this horse
so the center of balance is actually way far forward. And this is much more central on this horse’s
– this horse’s foot is properly prepared, it’s much more central and this horse is actually
going to stand much more comfortably. The shoe goes back on and I can see that the
heels are much wider, the surface the horse is actually going to walk on now and ensure
the load of this weight is on is much larger so the force per square inch is quite a bit
different now and much improved. And then the webs of the heels are far enough
apart that they’re not pinching on the frog. I hear that nobody can see my arrow so I apologize
for that. Let me go back and just do that one horse
one last time. If you can see the heels here are pinching
in on the frog – can you guys see the arrow? I hope so anyways. [Amanda Bodle] No, okay. You may try closing out of your sidebar. [Dr. Ann Rashmir] Okay. [Amanda Bodle] And just see if that has something
to do with it. [Dr. Ann Rashmir] Can you see it now? [Amanda Bodle] Nope. Click on your arrow again. [Dr. Ann Rashmir] I did, can you see it? [Amanda Bodle] No, I sure can’t. [Dr. Ann Rashmir] How about if I use this
and the whiteboard overlay? I think I’ll use this. You guys can see that, right? [Amanda Bodle] Yes, I can see you drawing. [Dr. Ann Rashmir] Okay, good. Okay, well we’ll try this then. I’m sorry, I apologize. Okay, so just to show you that this is a much
smaller surface area here now – you can see that, right? Yes? Okay. I’m sorry. Much smaller surface area, and this area as
well, this is just with the shoe off. And a much wider surface area now that you’ve
got the shoe properly prepared. And then again, the heels here, the shoe does
not impinge on the frog at all, and the heels are wide enough to allow for heel expansion
– heels of the shoe are wide enough to allow for heel expansion of the horse’s foot. Okay, so here the horse’s now uncomfortable
and standing up on its toe with an obvious, the lines on his hoof. And here’s the horse actually after that first
set of shoes was put on. So again, much more upright just overall,
much shorter, the horse is much more comfortable. And the I see here also, can everybody hear
me? I can actually see that somebody has indicated
that they cannot hear. Okay, good. Looks like some people can hear. And here’s the same horse after the shoe,
now he’s grown out about six to eight weeks and you can see his toe again is trying to
get long, right in here. So this is a horse again, that needs to be
consistently trimmed appropriately to keep his heel balance and his toe balance and his
center of gravity in appropriate position. So here he is again after his second shoeing. And again, a much more normal hoof/pastern
axis and a much more comfortable horse. And this is that same horse looking from the
back side. I think you can see here very nicely, the
heel support of the shoes – we can actually look from the horse’s, from the back of the
horse’s foot and see the heel support. And that’s the way it should look. Now I do have clients that tell me that their
horse will pull the shoes off and that is the case in some instances. I generally have those horses wear bell boots
full time, the gum boots work very well. It can actually come down and cover the heels. We do ask you to look underneath those bell
boots every day to make sure that they’re not rubbing the horse. But again, consistently they can be worn to
protect the heels when needed for horses that have the big strides. Okay, so that concludes a little bit of lameness
– or sorry, shoeing as it pertains to lameness that I wanted to address today. And I wanted to move along to some lameness
with thermography. And thermography is actually the heat that
comes out of the horse’s body or your body with a thermal camera. It’s a very specialized camera, it’s the same
sort of camera that they use when they’re trying to determine if somebody gets off the
airplane with SARS or another infectious disease and has a fever. And so it’s a very sensitive camera when we
use it for horses to determine lameness. It also can be utilized to determine problems
with saddle fit and that’s what we’re going to concentrate on today. But it’s a non-invasive tool and again, it
is body surface temperature driven. If you’re going to use it as part of the lameness
examination, you should generally get a thermographic image prior to starting the moving part of
the lameness examination. And what you’re going to compare is right
leg to left leg, both front and hind, and left side to right side of the horse. The signals should be symmetric. Any change of heat seen with the thermography
is generally a result of changes in blood flow. And the baseline you took before you trotted
the horse is then used to compare a later examination of the horse. And I think you can see here, this white is
a hot area on the horse, this horse has got some tendon issues. And you can see this is the upper part of
the limb, fetlock, and then also the foot of the horse. As far as saddle fit goes, and I said we’re
going to use some thermography to look at that because I think it really nicely illustrates
the problems that can occur. The saddle can be having a problem – or the
saddle fit can be abnormal because the saddle itself is asymmetrical, it can be a problem
because the rider is asymmetrical, or a problem because the horse is asymmetrical. The problem is that most commonly the only
thing we can fix well is the saddle. So that’s what we generally concentrate on. Or sometimes we can fix the rider as well. So let’s look at this. This is a thermographic signal with one of
the floor cameras. And this is courtesy of Dr. Jim Waldsmith
who does quite a bit with thermography and teaches many of the thermography courses. And I think you can see here, this is the
scale for temperature. The purples and blue are cooler and as you
get up into red and white it gets to be much hotter. And this is an English saddle as you can see
here, this is the back of the saddle, the flaps, etcetera. And so here you see a fairly red area right
here, and that’s the sign that that’s actually created more heat than the rest of the saddle
because it’s – due to friction with the saddle and the horse. I think you can see this is the horse, here
are the horse’s ears up here, the neck, the mane, here’s the person holding the horse
here, you can see she has a v-neck blouse right here. And this is the horse’s withers and you’re
looking at the horse’s hips. And I think you can see this horse is actually
asymmetrical. Here’s the line – this side is bigger than
this side and that corresponds to the heat seen right here on the saddle. It’s not that surprising that the horse is
asymmetrical. Your right hand if you’re right-handed is
probably bigger than your left hand. We do see this sometimes in horses as well
but they will be bigger on one side than the other. And so this, again, would be something where
if you could adjust that saddle, it might make this horse’s withers more comfortable. In fact, this horse was presented for soreness
at the withers and it’s no surprise since there’s more friction here with that saddle
not quite fitting as well on the right side as the left side. Here’s a Western saddle, similar thing. I think you can see here that this horse might
be a little asymmetric as well. But certainly – here’s the back side of that
Western saddle. Certainly can see here quite a bit of red
in this area. And again, meaning that it is hotter in that
area. You can see that little bit of red also on
the horse. Again, this is a saddle that could use some
alterations to make it more comfortable for the horse. So, let’s move along to our traditional lameness
examination. We do start at the horse’s head and look for
symmetry. We do palpate all the way down the horse’s
cervical spine. It’s sometimes difficult to tell if the horse
is actually lame or if the horse is neurologic. And so one of the things that can give us
a clue would be palpation of the spine. Also, it will give us a clue as to whether
the horse’s neck is painful. Certainly, horses can be lame from neck pain
just like you if you’ve ever had a stiff neck and you’ve been trying to drive your car,
you don’t move your whole body or – sorry, you don’t move your neck to turn to look to
the right or left, you actually move your whole body generally. So horses can actually have a hard time turning
which is perceived obviously as a lameness because of neck pain. Do take a good feel of that area. Again, looking at the scapula, humerus, radius,
and ulna down to the carpus or knee, fetlock, pastern, and coffin joint, foot. We do palpate all this, all the way back,
the horse’s back, all the way down the horse’s hindlimb as well. Palpating the pelvis, the femur, tibia and
fibula, the tar- sorry, the hock or tarsus, fetlock, foot, etcetera. Now, we’re generally looking for symmetry,
we’re definitely looking for heat or pain, we’re also palpating all of the muscles, ligaments,
tendons, and joints along the way. We are cer- we are in addition looking for
some compensatory problems. We know that horses, for example, can have
sore backs from having sore front feet and that’s actually fairly common reason why horses
do get sore backs is because their front feet are sore or their hocks are sore. They can also have primary problems with their
backs such as saddle fit in the withers area which can make the withers directly sore or
overriding vertebra, the withers make them sore. And then Narelle’s going to talk a little
bit I think about backs. She’s got a very nice study now looking at
some diseases that are primary to the thoracolumbar spine. So sometimes the lameness will be very subtle
in the feet but yet we can feel some back pain. We need to kind of tease that apart. Maybe it is the feet, maybe it is the back,
and maybe it is a combination of both things. But in the general lameness examination with
the palpation, it’s something that we actually want to start getting clues on. And every bit of the lameness examination
will be recorded. So continuing with the standing part of the
lameness examination, we look to the hoof testers. These are very nice hoof testers. All hoof testers are not created equal! These are GE hoof testers – you can actually
have very good leverage on them and get a very nice squeeze on the foot. When you do a comprehensive exam of the foot
starting at the heels and working all the way around the sole of the foot, if there
are – if the horse is acutely lame after shoeing, within the next day or two after shoeing we
do tap the nails on the foot looking for perhaps a nail that’s too close to that white line
or sensitive laminae. I think you can see on this horse also, long
toe, low heel. And what does he got here, the little bit
of redness? He’s actually bleeding down the front of his
foot or his laminae. So hoof testers are a key aspect of the lameness
examination in part because most lameness does occur in the front feet of the horse. Eighty percent of the lamenesses estimated
do occur in the front feet of the horse. So if you ever want to look smart and just
guessing, guess the front feet because more than likely you will be correct. Now, sometimes these feet will be very very
sore, let’s say a sole abscess, foot pain can be in the soft tissues of the foot, can
be the navicular bone, can be the coffin bone, can be anything. Sometimes it will be very very sore. And then sometimes you kind of wonder, particularly
at a pre-purchase examination, if there’s no sensation because you can actually squeeze
this pretty tightly. If there’s no sensation, we worry that the
horse has already had a neurectomy say, for navicular disease and at that point I look
at those horses very very carefully. So you should have some sensation but should
not be painful during this examination. As far as the forelimb lameness, we are going
to show a video here in a second but I do want to make a few comments. We do look at both forelimb and hindlimb lamenesses,
both in a straight line from the front of the horse and from the back of the horse. And also in circles. And I would encourage you to look at both
from straight lines and in circles when you’re looking at your own horses for lameness. The traditional thing we look at for the forelimb
lamenesses would be the head bob, ‘down on the sound’ basically. The weight of the head and the neck and shoulder
area is carried on the most comfortable leg. So to give you an example of what this would
be for you, if you were trying to carry say, a tool chest and your right wrist hurts you
or your right ankle hurts you, you probably carry your tool chest in your left hand – taking
the weight off the most uncomfortable area like your right ankle or even your right hand. If the horse is bilaterally lame, so that
means lame in both front or both hind legs, you’ll have to watch the horse in a circle
to better assess lameness. Generally the inside leg is under greater
stress and under greater weight and generally it’s the inside leg that you will see that
will be lamer; inside leg on the circle that will be lamer. So the right leg on a right circle or the
left leg on a left circle. Now occasionally, you’ll see the outside leg
be the more lame leg, in which case we generally see that the inside part of that outside leg
is the source of the pain. And so if, Amanda, you could play that video,
I would appreciate it. We’re going to watch this horse a couple times. And this horse is lame and you can see right
here. I think it’s right here as the horse goes
down, his head – the whole way his head is going down. Down, down, down, down, down, down, down,
down, down. We watch this again in slow motion, and I
think in slow motion, if you’re watching very carefully, you can actually watch the whole
horse’s body sink into that sound leg. Down, down, down, down on the right front
leg. Down, down, down. Again, you can see the whole horse’s body,
most noticeably the head – down, down. Come back this way again. Down, down, down, down. Hips not moving very much at all, very symmetrical
behind so we know that’s a forelimb lameness. And the hips not moving, head is moving, down
on the right front, lame on the left front. So let’s go to hindlimb lameness now. Hindlimb lamenesses again, evaluated in a
straight line and in circles. I’ve just shown you a straight line because
I think we can actually see these lamenesses. I have chosen lamenesses that I believe are
fairly severe. Now certainly, the performance horse lamenesses
are going to be much less severe but much harder to see and so we’re going to continue
to look in the straight line and I think it helps because you can line the horse’s head
up against that wall and it might actually help you see the head bob. Same thing is true of the hip hike. Hip hike is commonly used in the evaluation
of hindlimb lameness if it’s elevated when the lame leg is on the ground; same thing
as for the head – the weight of the head and the neck and shoulder when the lameness is
on the front, the hip is elevated when the lame leg is on the ground. So the weight of the hip is off the lame leg. Head bob can also be used for hindlimb lamenesses
but the head will be down or forward when the lame leg is on the ground. So ‘down on the sound’ only applies to the
front leg, not the hind leg. So next we’re going to watch the hindlimb
lameness video. Again, we’ll watch this horse in a straight
line from front. Here you can see the whole horse’s rear end
moving up – up, up, up, up, up, up, up, up, up. And once you start looking at that, you can
also notice that his leg swings in quite a bit. Here he is from the side – up, up, up, up. His head is fairly flat and level but his
rear end is moving quite a bit so we know this is a hindlimb lameness. Up, up, up, up. In slow motion you can see it even better. Up, up, up, up, up. You can see the leg swinging in as well as
to avoid flexion of the limb – swing in, swing in-hip up, swing in-hip up, swing in-hip up,
swing in-hip up. I think this very nicely demonstrates a left
hindlimb lameness in this horse. These videos are courtesy of Dr. Bob Lindford
who worked with the other – he and I worked together at Mississippi State for about fifteen
years. Up, up, up, up. Again, the whole horse’s rear end is lifting
up and that left hind leg is hitting the ground. I think you can also hear the sound of the
horse hitting much harder and that’s another clue to which leg is limb – which leg is lame. So I did want to mention that subtle lamenesses
which can affect performance are frequently better seen with the horse under saddle. And so subtle lamenesses and frequently hindlimb
lamenesses as well are better seen with the horse under saddle. So after we watch the horse trot both in circles
and straight lines, we do then perform flexion testing on the horse. So the horse has been trotted for a baseline
lameness. We flex up each individual joint and then
we trot the horse back off and compare the original lameness to what we’ve seen after
the flexion test. Originally in part of the lameness examination
when we’re palpating, we have actually already picked up the limbs and flexed them as well
when we’re hoof testing, actually before hoof testing frequently, but now we’re actually
going to hold the limb in flexion. And this is a flexion test of a fetlock and
we generally hold this for thirty seconds, trot the horse off. This would be a hindlimb fetlock flexion test;
this is a little bit misleading because it actually flexes up the hock and the stifle
and the hip as well because of the way the horse’s stay apparatus is that we flex everything
up together in the hind leg. The stay apparatus is what lets the horse
sleep standing up. It locks everything together and so you have
very difficult time isolating these areas from one another. But anyway, fetlock flexion and front – carpal
flexion in front, we generally hold this for a minute and a half. The fetlock behind, generally another thirty
seconds, and then this is what we call traditional spavin testing which is flexion of the fetlock,
hock, and stifle and hip as well. And so horses that have lameness in any of
these areas will be painful in each of these areas upon flexion testing. I do want to say a word about the specifics
of it though. Again, this spavin testing is going to actually
stress most of the joints in the hindlimb. The fetlock testing in the front limb can
actually be very positive not just from fetlock disease but also in horses that have navicular
disease, it does actually create some stress back in the navicular bone because of the
– where the tendons lay in respect to the navicular bone. So it will help you get an idea of where the
horse is lame, perhaps. But it may not tell you the whole story. So for the whole story, we really need to
move along to nerve blocks and joint blocks. This is very similar to when you go to the
dentist and so you’ve either got a cavity that needs to be filled perhaps would be the
best explanation, and the dentist injects a little Novocain in there – the area that
he’s injected into becomes numb and it takes away the pain or painful sensation of drilling
then. And so that’s exactly what we’re doing. For horses, we’re actually numbing the areas
of the foot first and then moving up the leg to the point where we see the horse is now
sound. So the injection is made low down first, walking
the nerves to the collar part of the foot. The anesthetic agent is allowed to work generally
for ten to fifteen minutes and the horse is trotted off again. And if the horse is sound, we know that is
the area that’s causing the lameness. And so we then focus on that area for our
diagnostic radiographs, ultrasound, etcetera – MRI. So if that does not make the horse sound,
we move up the leg until we get to the part that’s blocked and the horse is now sound
so we know if it blocks the fetlock – that the source of the lameness, if it blocks the
carpus – we know that’s the lameness. Okay? So you basically move up the leg until you
get the sound area. Once the nerve block has taken affect – sorry,
until you get a sound horse. Sorry, let me say that again. You start your nerve blocks down low, and
you see if the horse is sound after that nerve block works. And if that doesn’t work, we move up to the
next area. If the horse is not sound then, we move on
up the leg until we get to the part where the horse is now sound. And we know when the horse becomes sound,
that that is the area that is the source of the lameness. If you don’t do nerve blocks or joint blocks
on the horse, you may actually not have the correct area for lameness. We do see that quite often actually that people
will present thinking the horse is lame in one area and it’s actually lame in a different
area. But the nerve blocks generally are the first
line of defense in actually telling where the horse is lame. Again, we certainly can’t ask them like our
doctors might ask us, “Where does it hurt?” And this is our way of basically asking them
where it hurts. Okay, we’re going to go ahead and move along
a little bit to gait analysis which can be actually an adjunctive therapy or adjunctive,
sorry, diagnostic for lameness examinations. And this comes from Dr. Hilary Clayton who
is one of the preeminent gait analysis individuals in the country and she does actually have
– actually she’s one of the preeminent lameness gait analysis individuals in the world. And she actually does have the state of the
art equipment actually, currently with ten cameras and six imbedded force plates. But to give you an idea, this horse is actually
standing on a force plate. Now we normally bury those so the horse can’t
see them so it doesn’t alter the horse’s stride. But you can actually see the horse standing
on a force plate here, and that is actually hooked up to this computer and you actually
can see on the computer how much force the horse is putting on the plate. In addition, the horse has actually got markers
on it and the cameras are actually then able to determine the position of different parts
of the horse’s body with respect to its movement. So this is a horse that’s actually now doing
a canter pirouette on force plates. So here we are with piaffe on the force plate
and then we’re going to show you what that looks like on the gait analysis. So if we could prepare that video as well. Force plates are in here – you cannot see
them. The cameras are here and they’re actually
filming the horse and so….so here we go. You can actually see the force of the horse
as it strikes. These lines actually indicate the force the
horse strikes with and the cameras have picked up the outline of the horse. I wonder if we could play that back one more
time. So here we go, the horse is moving, there’s
the force. Again the cameras are picking up these reflectors
that have been placed on the horse and you can actually see the movement of the horse’s
limbs so you know which limb is actually striking with which force. Now most lamenesses that we’re going to see
won’t necessarily need this gait analysis, but for very subtle lamenesses it can actually
be something that can be very – of great interest. So it may be the most useful distinguishing
between the subtly lame horse and the subtly neurologic horse. So if you actually put one foot on each four
different force plates, you can measure with the horse standing and maybe even moving and
maybe make a determination better if the horse is slightly neurologic or if the horse is
slightly lame. Currently the treatment for the slightly neurologic
horse is actually give them a little dose – actually not a little dose. Give them a full dose of Marquis and see if
the horse responds. And certainly, this would be something that
would be better diagnosed by gait analysis than by simply trying to treat the horse and
seeing the response, or potentially anyway. Once we isolate the area of lameness, we’re
generally ready for radiographs or also known as x-rays. And it is the first choice for imaging bone
in the horse. It is the least expensive of the alternatives
for imaging bone and I’ve given you some examples here of the – this is the tarsus or hock of
the horse. And this is a normal hock of the horse here. And these areas right here are the ones we
frequently concentrate on because these are the most important areas for lameness in the
performance horse. And this is a very normal tarsal/metatarsal
joint, and this is the distal intertarsal joint. And I think you can see on this horse, he’s
got quite a big lip right here, okay? This is a very abnormal tarsal/metatarsal
joint, or the distal joint in the hock. And here is the distal intertarsal joint right
here which is actually fused in this horse. And then when you look at the x-rays, you
can see here that big spike of the tarsal – sorry, the tarsal/metatarsal joint. Did I say that wrong? Sorry, tarsal/metatarsal joint here. And here’s the distal intertarsal joint right
here as well. It has disease and is starting to fuse. So initial radiographs are better – I guess
we’re having problems with the pointer again and I apologize. And maybe every time we go to a video it cuts
off my pointer. Let’s see if I can get back here, sorry. So anyway, here’s that distal intertarsal
joint, tarsal/metatarsal joint here. I don’t know if you can see the pointer now
you guys. Can you see that? And here’s the fused joint here, or partially
fused joint here. Okay good; thank you! And then here’s that big lip on this horse
here which you can actually see here in the radiograph. So there’s the abnormal distal – sorry, that’s
the [INAUDIBLE] joint right here. And here’s the abnormal tarsal/metatarsal
joint right here. And again, radiographs are a fairly inexpensive
way of looking at this. The problem with radiographs is they actually
need quite a bit of bone change to occur, about thirty percent difference from normal,
needs to have occurred before you can actually see a change in the radiograph. And so certainly our eye has much better contrast
and much better to see early changes in the bone. Digital radiographs are actually quite a bit
better than standard radiographs. And I think that many of the performance horse
veterinarians have actually gone to digital which actually helps them quite a bit. Okay, so let’s talk about diagnostic ultrasound. For the horses that we suspect a soft tissue
lesion, and some actually bony lesions as well, but mostly soft tissue lesions; ultrasound
is going to be our best bet. And it’s first choice for imaging soft tissue
and you may know ultrasound from your horse but you also may know of it from somebody
you know that’s had a child. It is commonly used to image the fetus in
human pregnancies. Ultrasounds use classical sound waves that
you cannot hear, that are a different pitch than we can hear, and the sound waves travel
differently in the different tissues. And so what I’ve done here is I’ve actually
shown you an abnormal suspensory ligament in this horse. I’m going to show you where that is. So, this is superficial digital flexor tendon,
deep digital flexor tendon, and suspensory ligament right here. Okay? And so if we look at it this way, okay, with
a transducer or the probe for the ultrasound, we’re looking at the tendons this way. So superficial, digital, and suspensory ligament
right here. If we’re actually going to make a slice this
way and look at it, you can do that with the ultrasound probe by just turning the head
in the transverse direction. So there’s the superficial on the outside,
here’s the deep, and there’s the suspensory ligament. I think you can see this very large hole in
the center of the suspensory ligament is quite abnormal. It’s markedly enlarged, the hole ligament
is very large and it’s got what we call ‘hypoechoic core lesion’ which is a big core lesion right
here and it’s a black area which is making it – which is what the term hypoechoic means. So this horse has got a very large suspensory
ligament lesion or suspensory desmitis. So we’re going to talk a little bit more about
ultrasounds when we talk about bowed tendons. And here we’re talking about the superficial
digital flexor tendon which is the most superficial and this is an outline here which looks really
normal here. I think you can see now that you’re starting
to see some holes in here and this is a horse that’s got tendonitis or a bowed superficial
digital flexor tendon. And then here, this black area again, the
hypoechogenic area is fairly large. And this is a very large lesion in this superficial
digital flexor tendon. And again, that’s a bowed tendon and is best
picked up with ultrasound. So, here’s what you’re really looking at or
partly what you’re looking at here, that large lesion and superficial digital flexor tendon. And here you can see, this is a tendon in
cross section and this is the area where the horse actually bled into the tendon. This is actually an early lesion. And so what you’re seeing is that sort of
change here in your ultrasound. The other thing that ultrasound is extremely
good for is seeing when it’s time to send that horse back to work. We know that when this area still has a hole
in it, those tendon fibers are not healed and that horse going back to work would only
result in rebowing the tendon or having additional problems with the tendonitis and potentially
becoming a chronic problem for that horse. And so we definitely would love to have the
ultrasound looking extremely good by the time that the horse goes back to work. Now, having said that, horses with tendonitis
– and that could be superficial digital flexor tendon, deep digital flexor tendon, and certainly
the check ligament and the suspensory ligament. All of those structures actually – each one
of those diseases, the horse needs to be in some amount of work shortly after it gets
injured. And what that does is it lets that fiber pattern
line up appropriately. And so horses that get walked religiously
after having an injury to one of the tendons or suspensory ligament or the check ligament,
the horses that started walking and actually go up from there to exercise slightly with
somebody having the horse in hand – those horses do much better because the fiber alignment
is better, the healing is better and the long term use of that horse is maintained. We do follow that ultrasound so once the lesions
start filling in when the exercise gets increased gradually so as the horse can tolerate it
and the tendon can tolerate it, the horse’s exercise gradually increase and increases
to the point where you can actually get on the horse, start riding. Again, we do bring horses back periodically
for re-checks to make sure we’re not over-doing it with the exercise. I did want to point out some contributing
factors that we probably need to consider when we have a horse with tendonitis or bowed
tendons. We already talked about improper shoeing and
that is a significant factor. Uniform trimming regimen is something that
we probably ought to take a minute to address. Horses that do the exact same thing every
day are actually at more risk for having a bowed tendon or getting tendonitis. We should generally vary the horse’s activity
so if one day you take the horse and say you’re working a dressage horse, certainly at some
point or another not doing all of the move or doing different moves on different days
would help that horse. And a day off where you actually do something
besides dressage would even be better for that horse, if you possibly can. So anyway, changing the regimen up is good,
and a horse that gallops a lot, you might trot them more on certain days of the week. And again, there – the training regimen of
the horse is so important that it really ought to be a whole presentation in and of itself. We certainly know that fitness is a problem. Horses that actually have been put in stalls
for quite a period of time because they’ve hurt some other area or even babies that are
stalled because their mother is sick or they’ve got some respiratory infection and have to
be stalled, or even a colic. Those horses that have had prolonged lay-ups
certainly needed – gently address going back to their level of training. We do see horses that get turned out for the
first time in a long time, they go out and buck, kick and play and come back with a bowed
tendon. So we do want those horses that are really
out of shape to actually get some level of fitness even before they’re turned out. Lack of an adequate warm up can be a problem
in these guys as well. And then I do want – because I can see here
that I put it in a different color, preexisting or unresolved lamenesses can be a significant
problem for horses with tendon trouble. Or for horses that can cause tendon trouble. So what happens is the horse is actually lame
for some other reason – maybe never even recognized by the owner or maybe just suddenly off – the
horse is actually used really hard. And what has happened is the lame leg is actually
putting more wei – or causing the horse to put more weight on the good leg. And frequently it’s the good leg that goes
on to then have tendonitis or have bowed tendons because it’s over-stressed due to lameness
on the opposite limb. It can also be the same limb as well. As far as conformation goes, there are horses
that are more predisposed because of their conformation. Stride characteristics are particular to an
individual horse and create more problems for the horse’s tendons. Reperfusion injuries are something we don’t
think about with tendonitis but that would you basic bandaging bow, so horses that have
got a wrap on that’s too tight that can actually result in a reperfusion injury with the tendon. Again, the nature of the working surface – we’ve
addressed that a little bit but again, it’s critical to keep those tendons happy and we
know there are some age related changes in the tendon that can actually contribute. The next thing I’d like to address would be
bone scans. This is something that your veterinary practitioner
won’t have access to but certainly is readily available at a referral center or practice
or university either way. What happens is a radioactive material is
actually injected into the horse, or a short-acting radioactive material. And then that’s imaged with a gamma-camera
and it picks up where the radiation is concentrating. It concentrates in areas where there’s increased
blood flow and that area would be, generally, the source of the lameness. And you can actually look at both soft tissue
with this and also bone metabolism. So just to show you, this is a normal foot
right here. And this is a foot that’s had a bone scan
and this is normal for that horse. And just like thermography, we do compare
the right side to left side. So here’s a normal foot and you can see the
hotspot on this. And you can see there’s a problem in this
horse’s coffin bone, or third phalanx. Bone scan is particularly good for horses
that have very difficult lamenesses to diagnose. For subtle lamenesses, intermittent lamenesses,
multiple limbs can be involved that make it harder to perform a lameness exam. Or if there are so many areas that it becomes
a bit of a frustration for the veterinarian to perform
a standard nerve block, generally a bone scan is recommended as the head of anything else
you might do. You might go back and confirm with nerve blocks
at that point for some simple areas. Certainly in a horse that has a very difficult
time with needles, it would be preferred to the standard lameness examination with nerve
blocks and joint blocks. It’s good for early detection of skeletal
injury like fractures before they become complete fractures. And occasionally we use it for poor performance
in general – looking for a place that the horse may be sore that might be difficult
to diagnose. But certainly those horses that have thoracal
lumber pain or back pain or pelvic region pain – again, they’re more difficult to diagnose. We can’t reach them with nerve blocks particularly
and those horses would be good candidates for bone scan. Didn’t want to move along to MRI, this is
going to be state of the art currently for horses and this is actually one of the more
state of the art MRIs – this is a brand new MRI that we’ve just got at Michigan State
University and it can actually do a fabulous job imaging things we haven’t been able to
image before. So MRI, or magnetic resonance imaging just
like you would have if you were injured, this is a standard thing you would get say, for
a cruciate tear. They do – the MRI does provide the ability
to see bone pathology and soft tissue structures at the same time. It is the state of the are for imaging both
bone and soft tissues, and occasionally the ultrasound actually can overturn something
and sometimes you come back with an MRI to discern what really is the problem. In addition to standard problems you can see
in the bone, you can actually even see edema in bone. Anyway, all the soft tissues will image the
digital flexor tendon, suspensory ligament, superficial flexor tendon and I think it’s
particularly good for the soft tissues of the foot where in the past sometimes we’ve
diagnosed navicular disease or navicular syndrome in a horse without knowing exactly what was
wrong with the horse. It’s a difficult area to image with the ultrasound,
looking at the soft tissues of the foot because the hoof can prevent some of that. The foot has to be beautifully prepared and
even then it’s sometimes hard to image with an ultrasound. Certainly the MRI is beautiful in those areas. I did want to mention on this horse, if you
can see here the suspensory ligament has got a problem, but also there’s actually a lesion
on the bone as well. So until this all heals, this horse should
not be returned to work. Now, I can’t leave off navicular disease because
we’re talking about performance horses and so – so that’s where we’re headed next. As far as common causes of lameness in performance
horses, I’m actually going to put arthritis here with arthritis of the hock, stifle, fetlock,
and coffin joint – probably the most common that I see. Soft tissue disease would be the superficial
digital flexor tendonitis with occasional check ligament either – and most common it’s
going to be the distal check ligament there, suspensory ligament desmitis is also a fairly
common cause of lameness in the performance horse. And that brings us to again, actually one
of my favorite’s, navicular syndrome because it is actually sometimes very difficult to
discern exactly what’s wrong with the horse. The syndrome part, the navicular kind of encompasses
many things, and again, that’s where this MRI can actually help quite a bit. So true navicular disease is the bone is affected. The navicular ligaments can actually be affected,
they can have bursitis and that actually is the area right here. So there’s the navicular bone right here. Can you guys see my pointer? I hope someone would say if they didn’t. Anyways, so here’s the navicular bone right
here, here’s the navicular bursa right here that actually goes between the navicular bone
and the digital flexor tendon, here’s the coffin bone right here, the short pastern
right here. And all these other soft tissue structures
in the foot; digital cushion is going to be in here, the suspensory ligament, the navicular
[INAUDIBLE] ligament, navicular etcetera. So any of these areas can actually be problems. Occasionally, because of the proximity of
the digital flexor tendon to the navicular – this navicular bone can get really rough
and actually get adhesions in the deep digital flexor tendons to the navicular bone and that’s
something where, unless that’s treated generally with tenoscopy, that horse is not going to
get better with any of the traditional treatments. So it can really give us a good idea, give
us an idea of what’s wrong with the horse’s foot with MRI and then we can focus on the
specific treatment. Okay, so traditionally navicular disease has
been diagnosed with pain to hoof testers, palmar digital nerve block – certainly the
foot would be cleaned up better before we’d actually put a needle in it but this area
would be numb, the horse would go sound then, we know that would be the area of pain, the
horse would actually have pain to hoof testers. You generally get five views of the fetlock
– sorry, five views of the navicular bone with radiographs. And then the horses frequently have a postive
fetlock flexion as well. So hoof tester exam, response to the palmar
digital nerve block or the heel block. These horses generally have a positive fetlock
flexion exam even though the problem isn’t the fetlock and then we do get generally five
views on x-rays. So I did want to talk about one view in particular
of the x-ray and I think this will hopefully help you get an idea of what’s happening in
these horses and why the treatments that we recommend might be helpful and probably – excuse
me [COUGHING]. Probably the one that might make the most
sense as a result of the radiographs would be the use of Tildren. And I’m going to show you why that actually
might make sense to you. Anyways, so here are the bones; the short
pastern, this is the navicular bone right here, here’s the coffin bone right here, okay? And so that’s what you’re seeing here – here’s
the short pastern, here’s the navicular bone. I’m going to actually try and outline it. Oops! Sorry! Here and then here’s the other surface of
the navicular bone, the flexor and articular surface of the navicular bone right here and
here is all navicular bone and then here’s the coffin joint right here. Okay, and this is a horse that had the normal
navicular bone. So, here we are looking at normal again, here’s
the flexor and articular surfaces right here. And you can see tiny little holes in here
like the drawing right next to it, so that would actually be normal for horses that have
been in use for any period of time almost. I think you can see in this view however,
here’s the cartoon of it – you can see the channels getting bigger now and here you are
with channels that are quite a bit bigger. And this is a horse that’s got increase channels
and this is of concern to us particularly if the horse has not had that much use but
even for a horse with a lot of use, those are pretty large channels. Okay, so here’s the normal again and then
you can see this horse’s channels have become so big that they’re really almost cyst-like. So the cyst-like lesions are actually pretty
severe or actually very severe navicular disease. There are other views of the navicular bone
that I’d love to go over with you but we do probably need to be conscious of the time
so I’m going to go ahead and move along. So classically, we’ve treated these horses
with shoeing changes which are good, we’ve talked about the importance of that, Isoxsuprine,
Bute, and coffin joint injections with hyaluronic acid and steroids or navicular bursal injections
with the same drugs. Generally the clients I’ve had use Adequan
in the muscle or Legend in the vein. Again, anti-inflammatory agents can help. And then, as a last resort, we do occasionally
cut the nerves or perform a chemical neurectomy on horses with navicular disease. If the disease is not so bad, the horse will
be in jeopardy of actually fracturing the bone. Now, what’s new for treatment of navicular
disease, and I’m going to add arthritis and tendon/ligament injuries to my group here
because some of these will actually treat more than one disease. The first one I’m going to talk about is irap,
stem cells have got a lot of press lately too. Platelet rich plasma is a newer drug, or sorry,
newer component of a treatment regimen. Tildren is actually something that has been
on the market in other countries, we didn’t do – legally get it in the United States now,
but it does have to be imported specifically for a horse. Rehabilitation and physical therapy are important,
and again, Narelle is going to speak about that next time. I did want to mention a few things about some
of the oldies and goodies that we’ve used for treatments long term, and I’m going to
talk to you a little bit about Bute, Banamine, Cosequin, a little bit more about Adequan,
Hyaluronic acid, and then shock wave if we have time. So irap therapy has actually had a fabulous
impact I think in the lameness world in the last several years. It was originally used in humans, United States
actually just used in the horse. And what irap is it is a protein that actually
interferes with a bad protein that the horses’ make. And so IL-1 which is interleukin one is a
bad substance that is made in horses when they have joint disease and it’s an important
mediator of arthritis. So we want to actually get rid of this IL-1
and so what irap is this IL-1, or interleukin one receptor antagonist protein, it actually
nullifies the effect of IL-1. So it’s the good treatment of a bad mediator
of arthritis. And with irap you – I think you can see that
these anti-inflammatory agents that are concentrated in the irap, they are concentrated several
fold. And so what we want to do, we want to use
the anti-inflammatory agents in irap and we don’t want to change the ones that are proinflammatory,
ones that create inflammation and I think you can see here that they’ve adjusted the
formulation of the [INAUDIBLE] so that the things that are proinflammatory or cause problems
are actually not increased. And so what does this mean for you and your
horse? Well, we actually take blood from the horse’s
jugular vein into a special syringe and I think you can see the syringe – there are
actually glass beads, you can see little beads in here. Those are actually specific so that they can
actually concentrate, they stimulate white blood cells to produce and concentrate, the
anti-inflammatory and regenetive cytokine – the substance is secreted by the cells that
will actually inhibit the arthritis. So the blood is incubated overnight with these
beads and then it’s centrifuged and collected into a specialized syringe that you will then
inject into the horse. It is filtered and done completely sterilely. In fact, generally when I do this I actually
wear gloves on both hands and this is a sterile surgical prep on the horse’s neck so that
we don’t have the opportunity to introduce infection into the horse’s joint this way. And it does work very well and it’s worked
well in a variety of joints; coffin joints, stifles, fetlocks – actually, quite a few
joints. And people are injecting in other things as
well like navicular bursa, etcetera. So irap is actually something that’s very
easy to use and is a standard sort of injection and comes from the horse themselves and so
it’s not necessarily introducing a drug into the horse so people like it for that reason
as well. Stem cells have got a lot of press lately
for a lot of reasons actually. You read Time magazine about stem cells even. But there are two basic types that we use
in horses; one would be a fat derived stem cell where you actually take the fat out of
the horse and grow the stem cells – sorry, harvest the stem cells and then inject them
back into the horse or this bone marrow derived stem cell where you actually – your veterinarian
would actually take bone marrow from, usually from the horse’s sternum and harvest that
and inject it back to the area that requires the treatment. Both work well. The fat derived stem cells have to be sent
off and your veterinarian can generally do the bone marrow derived stem cells in their
practice – performance veterinarians can. It does deliver active fibroblasts to the
area that’s a problem. So if you’ve got tendonitis, a hole in the
tendon, suspensory desmitis, any of those, you should see a improved healing and fiber
pattern. Again, you will get these horses back also
in light work like walking at the same time so that the fiber line is actually good so
the horse actually has a long term recovery. We do know that horses involved in jumping,
barrel racing, and other – at least the non-race disciplines have returned to performance at
their pre-injury level. I think the work on the racehorses actually
coming out or maybe has recently come out. I do actually want to talk a little bit about
this, I know we have a certain amount of time. Oops. And this is the slide that I lost my title
on but this is platelet rich plasma and this is basically the horse’s own blood. It’s [INAUDIBLE] and actually getting these
platelets out. These are what platelets look like on electromicroscopy
and these platelets actually have factors that are important for the growth of tissues. And so this platelet rich plasma is then injected
back into the horse, similar to what the irap is and it’s been used in the treatment of
several joint disorders, tendons, etcetera. And actually people are injecting joints as
well. It’s a little bit newer and not as much work
has yet been done on it but it is an up-and-coming drug, it appears. As far as Tildren goes, that is something
we talked about when we showed you the slides of horses with navicular disease. You did see those areas were starting to – the
bone or the navicular bone will start to be reabsorbed. And what Tildren does is it actually decreases
the function of the cells that eat that bone. So much like – in fact, this is a type of
drug that is used in women that have osteoporosis to wipe out the cells or alter the cells that
actually chip the bone. It does actually do the same thing in the
horse to alter the cell function so the bone is not getting chewed up and it changes the
remodeling of stress on the horse’s bone in that fashion. There is some good evidence with the Tildren
for horses with navicular disease, with back pain, and with hock arthritis. There are some new bisphosphonates that are
soon to be coming on the market apparently that may actually even one up the Tildren. Again, I’m not going to speak about rehabilitation
and physical therapy but Narelle will be speaking about it for an entire lecture. It is a critical step in the return to athletic
performance of all of these horses. Again, we’re at the tail end of the lecture
and I did want to say a few things before I let you go though about drugs that you commonly
give or are very familiar with. My first one is Bute and Banamine or phenylbutazone
and Banamine. Neither of these drugs really should be given
in the muscle. This is actually a sloughing of part of this
horse’s neck from Banamine. I’ve actually seen much worse sloughs of the
neck or injection sites where Banamine has been given in the muscle. I know it’s commonly done every now and then
a horse will get very unlucky and then occasionally horses slough so much that it – from then
on out it has difficulty with flexion of the neck. And as you know, performance horses can’t
flex their neck are not performing at the same level as the ones that can. The Banamine that you get, that you actually
have an injection in the neck, you can stick that right in the horse’s mouth, right out
of the bottle. You can mix it with molasses, stick it in
the horse’s mouth as per instructions from your veterinarian but it works very well. That same drug you have in the bottle for
IV works very well orally. Again, IV is no problem, orally is no problem,
it’s just the ones that are given in the neck that can occasionally become a bad problem
for your horse. The other thing I wanted to say about Bute
and Banamine, put Ketofin in that group as well – another non-steroidal, is that they
really should be given separately. And you’ll know – you probably are aware of
the new FEI ruling on the use of more than one non-steroidal drug as they’re called,
at one time. You actually don’t gain enough to make it
worthwhile to give both Banamine and Bute to the horse at the same time. However, if the horse needs both drugs to
be sound, then that’s a horse that probably should not be working number one, and two,
it’s double the toxicity or even, perhaps, more. So Banamine and Bute both can cause ulcers
of the horse’s mouth, esophagus, and stomach and right dorsal colon and they can also cause
kidney disease in horses. In fact, they can cause kidney failure if
given enough doses. And so, if you don’t get an adequate response
to one dose of Banamine, which is maybe five hundred milligrams in a normal horse or one
and a half to two grams of Bute in a normal horse. It’s not advisable to actually double that
up with either another dose of Banamine or another dose of Bute. Don’t exceed the recommended dose and don’t
double up one drug or the other. I did want to say a little something about
chondroitin sulfates and glucosamine. They are very safe in horses, it’s something
that’s fed to the horse on a daily basis – human athletes take it, horses take it, the have
it for dogs and cats now as well. It does – the combination does serve to protect
cartilage. This is an older bottle of Cosequin here,
they actually have AS units; sulponofod, avocado, and soy. And that actually probably is even a little
bit better – or actually even better anti-inflammatory. But I did want to make a point saying that
these chondroitin sulfate/glucosamine products are not created equally. There have been two studies so far. One of them – the first one I believe two
out of the ten drugs tested actually had what they said they had in them in the last study. And this is it; fourteen out of the twenty
three products that were actually sold as chondroitin and glucosamine – fourteen out
of the twenty three were actually adequate. So actually had what they said they had in
it. So stick with a name that you can trust for
these drugs otherwise you’re probably throwing your money away and potentially give your
horse something even, possibly, deleterious. So again, pick a brand that is a good brand. Again, I want to say a little bit about Adequan
and hyaluronic acid and corticosteroids. These are probably the mainstay of anti-arthritis
medications. These can also – they can actually be given
in the joint, okay? And they can also be given in the horse. I’m going to talk a little about steroids,
we generally don’t give these – or we shouldn’t administer these to horses before performance
for a couple of reasons. Actually, it’s best to administer all these
drugs sometime, somewhere between days and weeks before the horse actually performs. So the things I want to mention about Adequan
is that it’s a potent enzyme inhibitor and that’s why it works so well in these horses
that it does work in. Frequently I have clients that give the drug
once a month which is good. If you’re actually having a flare-up of the
horse’s lameness, it is one shot every four days for seven treatments. And so if the horse is actually maintained
on Adequan once a month, that’s fine. But if the horse has got an exasperation of
lameness, you may need to go back to that one shot every four days and you’ll get a
lot more bang for your buck that way. Certainly it’s a lot more buck though too. It does stimulate hyaluronic acid, proteoglycan
synthesis, collagen synthesis. I have here that it can be used in the vein
– that’s not right. It can be used in the muscle and in the joint
– I apologize for that. It can be used in the muscle. Not the vein and in the joint. Sodium hylauronate. So this is your Legends, your Hylartin, your
Hyviscs. They’re used in horses and in humans. They do reduce pain and increase mobility
in horses and humans with joint disease. They do compare favorably with the Butes and
the Banamines and the steroids, they’re anti-inflammatory, they can provide soft tissue lubrication,
we do use these drugs in the horse in the vein, and that would be your Legend in the
vein, and also directly in the joint. I do want to mention that not all sodium hylauronate
products are created equally. Legend is the one that’s licensed for use
in the vein. When you get down to the point where actually
you’re going to be using drugs in the horse’s joints thought for joint injections, and you
specify that the horse has fetlock lameness and you want to inject the fetlock joint or
your vet’s going to inject the fetlock joint, don’t ask for the cheapest drug to be injected,
ask for the best drug. And this is kind of something that’s worthwhile
looking at. Here’s Legend, very good in the vein, okay? And not that expensive. But as you go up the list here, these higher
molecular weight drugs actually work better. And so if you’re going to go to the trouble
of actually sticking the horse’s joint, okay, ask for the best one, not the least expensive
one for the joint. It’ll actually pay in the long run for you
and your horse. Whenever possible, I would say buy the best
drugs you can buy for your horse. And I do want to address that at the very
end as well. Now I see this a lot – corticosteroids are
still controversial in at least the way they’re used in horses right now. We do see horses that get frequently injected
with steroids because the horse owners believes or the trainer believes the horse might need
it. If you really look at elite athletes across
species, we don’t do this in anything but the horse that I can think. We don’t do it in dog athletes, we certainly
don’t do it in humans. If you’ve thought about one of your favorite
Olympic athletes, say Apollo Ono comes to mind, if you asked him “would you like some
steroid in any of your joints before you race in the Olympics?” I’m sure he would say no. Any injection will actually alter the feeling
for that joint, alter the proprioception for that joint. So it can actually make the horse’s foot flight
altered immediately after injection. If you are going to use these drugs, you try
and give them away from the time the horse is going to be exercised at first. And preferably in joints that actually need
it. So, they do have some negative effects. Also, the steroids at higher doses will actually
decrease chondrocyte metabolism or negatively inhibit chondrocyte metabolism and cause some
disorganization of the collagen fibers and that actually is long term – it’s going to
be a long term problem for the horse if that continues to be used in that fashion. And this is at high concentrations . At low
concentrations they actually tend to be pretty good in joints and actually sometimes very
very good in joints. They do inhibit potently those enzymes we
talked about before and the cytokines. Again, generally best at low concentrations
in joints that actually need it, not just as a preventative. The last thing I want to talk about is compounded
drugs and I did want to remind you about the twenty one polo ponies that died in 2009. Those drugs were compounded, okay? So compounded drugs are drugs that are compounded
by a compounding pharmacist. You might have heard of generic drugs, okay? Those are actually FDA approved drugs. A standard drug, again, FDA approved. Compounded drugs are the drugs that are compounded
by specialty pharmacists, compounding pharmacists, and they have not particularly had the scrutiny
in the past that perhaps they should have. I know the American Association of Equine
Practitioners actually has rules governing the use of compounded drugs. And again, the reason that those twenty one
polo ponies died was because they got an inappropriate compounded drug. So again, just another reminder to use the
best drug you can possibly afford. And that’s the end of my presentation for
today. I believe that I am supposed to now answer
any questions that have not been addressed. And I do appreciate Narelle Stubbs, she’s
been wonderful for answering questions as I’ve been talking along and I do appreciate
it. I see a note from Jody here about her vet
prescribing Acetylglucosamine for the barrel horse. It’s actually sort of a generic form of something
more like Adequan or a mix between chondroitin and Adequan. It is a compounded drug though, as far as
my knowledge. It’s only available from compounding agencies. And so it would be one where if the horse
responded to that, perhaps Adequan would be a better choice. I see also Peggy says she had a severe navicular
disease horse who is now quite useful, used natural balance shoeing. Certainly, the better job on the horse’s feet,
the more likely the horse is to be comfortable. I do appreciate you actually mentioning that. Thank you, Peggy. Okay, so let’s see here. I have are oral HA supplements effective? That’s a question from Lori. It’s interesting. The jury, I think, is still out on the HA
supplements. If I were going to spend my money on a supplement,
I would actually use the chondroitin/glucosamine combination like Cosequin. Let’s see what else I’ve got here. Stephanie has a compounded drug question. Her thirty two year old horse has Cushing’s
syndrome and takes a Pergolide capsule daily. Unfortunately, right now that is the only
way you can actually purchase Pergolide is by compounding. I believe [INAUDIBLE] should have a new product
on the market which is a FDA approved Pergolide shortly. I know that it is actually on the market in
Europe and it is – I think it’s in clinical trials right now and soon to be released. That study was actually partly done here and
Dr. Hal Schott would be better able to tell you when that drug is going to be out. But yes, right now that is the only way you
can actually get Pergolide. So yes, I would continue with it. Barb asks about shock wave therapy that was
used on her twenty three year old distance horse. He rode eight hundred miles last year – got
to love that, Barb. Good job! And it doesn’t say what she actually shock
waved the horse for but it can actually improve fiber alignment in tendons and ligaments and
people have used it for a variety of things as well. It’s – a human also treatment. So I’m glad to hear that it worked for your
horse. There’s a question from Janet about natural
herbal applications as anti-inflammatory aids. It’s interesting, some of the natural herbals
actually have a fermentative aspirin in them and so I’m just wondering how the – it would
depend specifically on the herbal medication. Certainly some of them are better than others
and we’d have to know a little bit more about your specific herbal. Personally, I would use the drugs that are
FDA approved as a first choice, however above the herbals. Do I recommend giving – Jody asked if I recommend
giving joint supplements to horses. If I were going to give one, I would give
one that would treat the whole horse and so, again, I go back to something oral like the
glucosamine and chondroitins or an Adequan shot as preventative once a month sort of
thing. I think those are reasonable things to – horses
aren’t lame but to actually keep them going. Yes, I think those are very reasonable and
I’d certainly rather do that then inject the horse’s joints with corticosteroids or whatever. And there’s a very nice study with Adequan
in particular, I believe, where the intermuscular Adequan actually decreased the need for the
interarticular medications in a group – in a fairly large group of horses. And so I would use Adequan or Legend depending
on what works better for you in those horses. What do I think about chiropractor – acupuncture
and chiropractic on soreness. I actually don’t do acupuncture but I would
if I had a horse that needed it, I would actually not hesitate to get the horse acupunctured. I would actually go to a – you know, my preference
would be somebody who is very well acquainted with acupuncture and very good at it. The same thing as chiropractic. Big span of abilities in both those fields. Certainly the veterinarians that have undergone
the acupuncture courses would be good choices. The people that have actually gone to the
four year programs for acupuncture are very good. I have a very good friend that – [INAUDBILE]
that has done a lot of acupuncture on horses and I’ve worked with her on some of those
and they seemed to do very well. So yes, I think acupuncture is good. Chiropractic, boy, big spend there. Kevin Haussler’s the genius on chiropractic
and I would definitely have him treat my horse any day. And then I’ve had chiropractors that weren’t
nearly as qualified or as good. And we know that horses don’t actually put
ribs out just like humans don’t actually get ribs out – it’s something a little bit different,
we just use the wrong terminology. But there are things you can do for the horse
and I believe Narelle will be addressing those as well. There are things we can do for the horse to
manipulate them to make them more comfortable to increase their flexibility and things like
that. And certainly if that’s what your chiropractor
is doing, I definitely would agree with that. So I do want to say thank you again to Narelle
Stubbs who’s been wonderful answering questions and actually I made her look at videos ahead
of time and I do appreciate that. And all the contributors to the notes – Dr.
Bob Lindford for the video, Dr. Hilary Clayton for the beautiful video and photos, our group
here in radiology for the MRI – it’s wonderful and we’re very pleased to have that new MRI. It’s been fabulous. Tia Nelson for the farriery and Jim Waldsmith
for thermography. [Amanda Bodle] Okay, I think we’re going to
go ahead and conclude. I just want to say a couple of thank yous
as well, especially to Dr. Rashmir for her presentation and again to Narelle for answering
our questions tonight. And especially to all of you for participating. And later this week you will receive an invitation
to participate in an online survey and if you would take a few minutes to give us your
feedback, that will really help us. [Dr. Ann Rashmir] We would really appreciate
you giving feedback for that survey. Thank you so much. [Amanda Bodle] Yeah. And also I want to let you know that, again,
next week our questions facilitator from tonight, Narelle Stubbs, will be giving a free webcast
on Rehabilitating the Lame Horse and then next month we will finish our horse health
series with an Equine Emergency First Aid free webcast. And I want to remind you that My Horse University
is now on Facebook so please become our fan and have access to exclusive deals and get
the most up-to-date information on our events, courses, and more. And again, tonight’s webcast was recorded
and will be uploaded to our website by the end of the week and you can send us your comments
and suggestions to [email protected] Thanks again, and have a great evening. [Dr. Ann Rashmir] Thank you, Amanda.

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  1. This was a great video. I’m thankful to you posted it as our horse is at UF undergoing an MRI right this moment to determine the cause of her lameness.

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