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I have a 12 year old paint gelding who was diagnosed with what

 

Customer Question

I have a 12 year old paint gelding who was diagnosed with what was then called navicular syndrome/now caudal heel pain approximately 4 years ago, after an initial diagnosis of suspensory ligament injury and numerous rounds of shock treatments. Three months later he was worse, a "3" grade lame at the trot and was laying down or constantly pointing his left fore when standing. With vet #2 we pulled his shoes, created a deep sand bedding, soaked his hooves for 30 mins a day and did a 3 month regimen of Isoxsuprine. After this treatment he was sound for about 4 months and then went lame again. The third time around with vet #3 we used shoeing based on xrays and did an additional 6 months of a low daily bute dosage (2 tabs per day one am & one pm) and Isoxsuprine on a gradually declining dosage (starting at 20 pills 2x and ending a 7 pills 2x). This time he has remained sound for the past six months for most part, but on an intermittent basis his gates become choppy be becomes unwilling under saddle and he appears to be uncomfortable after riding, shifting his weight from foot to foot for about an hour post ride. Will another round of Isoxsuprine help? Should he just remain on lower daily dose of Isoxsuprine or will he get more comfort from a daily pain reliever like previcoxx?

 

Optional Information:
Type of Animal: Horse
Pet's Gender: Gelding
Pet's Age: 12
Name of Horse: Tetanka

Already Tried:
Please see question for complete details.

Submitted: 359 days and 20 hours ago.
Category: Horse Veterinary
Value: $18
Status: CLOSED

Accepted Answer

Expert:  Dr. Braha replied 359 days and 20 hours ago.


Dr. Braha : Have you discussed with your Veterinarian performing coffin joint injections with steroids to help with the intermittent lameness?
Customer :

Yes, we had discussed that as a possible "next level" after the last round of treatments. I just feel that his current level of soundness and pain-free days don't warrant the expense of the injections. I know horse ownership is an expensive undertaking, but I'm also trying to manage his illness and the associated costs.

Customer :

So far I've spent well over $7,000 over the past 4 years, knowing that the injections may be inevitable I'd like to do it at the right time for his continued career as a trail/pleaure horse.

Dr. Braha : Very understandable ! The coffin joint injections can be economical if you get 6-9 months of effectiveness out of them. The length of time as I am sure your Veterinarian has explained depends on the degree of changes within the foot and the effect gets subsequently shorter with each repeated use. The way I tend to go about these cases are as follows:
Dr. Braha : Step 1: is to reduce the break over of the foot by shortening the toe and placing a regular shoe positioned just behind the toe to promote rolling from the toe releasing torque off the caudal heel area. Many clients will also elect to use joint supplements as this time to decrease the rate in which continued degeneration occurs. Step 2: is the use of anti inflammatory drugs Step3: Injections and lastly Step4: denerving
Customer :

I was reading a recent article on The Horse that suggested that injections to treat navicular can only be of optimum effectiveness if they are guided by an MRI and placed within a few centimeters of the correct site?

Dr. Braha : There are techniques to inject into the navicular bursa itself however steroids will diffuse across the joint and into the surrounding areas. Other products injected into joints such as HA (hyaluronic acid or Legend) will only stay where you put them. In this case it is essential to inject them directly into the desire area.
Customer :

So, according to your treatment protocol, since he is only experiencing sporadic days of discomfort he could still be at a stage where a daily low dose of an anti-inflammatory will temporarily return him to soundness?

Dr. Braha : It is possible that you can continue to maintain on a low dose of anti inflammatories on a daily or every other day basis. These drugs can be tough on the stomach in some horses and even on the colon when referring to using Bute. I would also not shy away from trying to see how long of an effect an injection would last eliminating the need for daily medications.
Customer :

Yes, OK, that's a very good point as well. He tolerated bute very well, but I've heard good things about previcoxx (sp?). He did colic about 9 months ago but that was when he was not on the 3

Customer :

bute and had just had a bad fight with another gelding.

Customer :

Horses! lol

Dr. Braha : previcoxx is an anti inflammatory that I see gets used from time to time. it is formulated for dogs but some believe it to be less harsh on the stomach than Bute. In my personal experience I find Bute provides better musculoskeletal pain relief over Previcoxx. Same reason why for a colic we give Banamine over Bute. All drugs are classified as non steroidal anti inflammatories but certain drugs have better effects for certain types of conditions.
Dr. Braha : He was receiving 3 grams of Bute per day?
Customer :

No sorry, that was my 3 year old son helping with the typing. :) He was receiving 2 bute tabs per day, 1 with his am feed and 1 with the evening feed (he's fed 3x per day)

Dr. Braha : Okay perfect ! Even though Bute is labelled for up to 4 grams per day for your standard size horse I don't like to see more than 2 grams used per day.
Customer :

He's 16.3 and tapes at 1400 lbs

Customer :

Well, I think you've given me some good information. I have a soundness exam booked with my vet for next week and I think given his fairly recent colic, trying a round of the injections may be the safest route.

Customer :

I just hope the soundness exam coincides with one of his off days, because the last time I was out he was near perfect.

Dr. Braha : there is medication called gastroguard/ulcer guard which does help to prevent the ulcers from forming when on Bute but can be costly even when compounded
Dr. Braha : There are two commonly used steroids to inject depo medrol and triamcinolone.
Dr. Braha : The depo medrol will last longer in action but it can cause calcification of cartilage in the joint.
Customer :

Hmmm... I've him on daily pro and prebiotics since the colic and he hasn't shown any signs of a re-occurrence. But he is more Thoroughbred than Paint in temperament as well as size/conformation.

Customer :

What are the name brands these injections are marketed under? Is one of them Legend?

Dr. Braha : My preference is to go with triamcinolone for high motion joints such as the coffin as it will not cause hardening of the cartilage but does not tend to last as long.
Dr. Braha : legend is not a steroid but is commonly placed into the joint. It acts to help lubricate the joint but will not decrease inflammation directly.
Dr. Braha : When someone says the injected " acid" into a joint they are talking about a product such as legend
Customer :

Sounds painful. What about additional measures for corrective shoeing, such as eggbar shoes?

Dr. Braha : There are lots of different theories out there when it comes to shoeing I keep it simple by using a regular shoe having it set just behind the toe of the foot and seem to have equal success with that technique.
Customer :

That's pretty much what we're doing and he seems to do as well as can be expected. My only complaint is that he dings the front of his pastern when he gets up and has a constant sore there as a result.

Dr. Braha : Haven't had anyone mention that before in associated with the shoeing technique before I wonder if the two are related or a technique for getting up he has developed to avoid access pressure on his foot!
Customer :

Ah! That could be the case, the sores started after he was reshod after having his shoes pulled for about a year (when he wore the removable boots when needed).

Dr. Braha : Sounds like he keeps you busy!
Customer :

Yup, he's one of those horses. lol Thank you for your help!

Dr. Braha : You are very welcome :)

Expert TypeEquine Veterinarian
Category: Horse Veterinary
Pos. Feedback: 95.3 %
Accepts: 221
Answered: 4/14/2012

Experience: Equine Veterinarian

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