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to supplement or not to supplement
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barbarac
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 Posted: Fri Dec 9th, 2016 09:21 am
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Hi Dr. Deb,
I noticed in an old post you are not keen on glucosamine and chondroitin, or so it seemed. In researching it I see the issues with efficacy and am now wondering if the Cosequin ASU I am giving to a horse who had a suspensory ligament injury and now some mild arthritis in the hind fetlock is necessarily benefitting from the high cost of the supplement. The arthritis has not reached the joint as of yet and the vet said that it appears stable and the horse is sound and happy. She says arthritis does progress as they age and will at some point become an issue, till then its maintenance and keeping him moving is probably the best medicine of all.
Do you have any advice on supplements that you feel can help in this type of situation? I don't like throwing my money away, but will gladly spend it on something that appears to have more science behind it.
Thank you

DrDeb
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 Posted: Fri Dec 9th, 2016 02:56 pm
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Barbara -- on your previous query in the other thread, I did give Pauline Moore a beep to alert her it's there....she'll get back to you as soon as she has a moment, I expect. Pauline knows more about sourcing than I do.

As to glucosamine: I'm not against glucosamine, especially glucosamine hydrochloride administered IM. This bypasses the digestive tract and allows the substance to have maximal effect and thus the greatest bang for your buck. See if you can find a veterinarian willing to work with a compounding pharmacy. You then buy a stock bottle of liquid glucosamine hydrochloride, the vet supplies you with the needles, and you then give IM's to your own horse, which is absolutely legal. There is a protocol for this which, if your vet doesn't know it, I will communicate to them if they will EMail me. I obtained the protocol not by making it up myself, of course, since I'm not a veterinarian, but from my own veterinarian.

As to chondroitin, I think it's actually contra-indicated. Not only has it been shown (by the very science you're asking for) to be even less digestible than glucosamine (sulphate, hydrochloride, whatever form), many horses and people actually are allergic to it, which results in joint swelling and other symptoms.

On MSM, another compound often found in commercial products, I'm neutral; I don't know of any harm from it but I'm not impressed with its efficacy particularly either.

As to arthritis 'progressing': there's a miscommunication here somewhere. Arthritis by definition affects joints; there is no arthritis anywhere else. You may be mixing up arthritis with arthrosis or exostosis or bony proliferation, but those too would be found around the edges of joints (arthritis would be bony changes inside the joint). In other words, these are not conditions found in soft tissues, nor do they affect soft tissues, other than unless you get such a great amount of exostosis or bony proliferation that it begins to impinge upon, interfere with, or rub and abrade some soft tissue.

I am a fan of injectable glucosamine hydrochloride as a support to the health and soundness of horses that are beginning to put on some age. And you're right to think that 'keeping the horse moving' is good policy. However, it's important to note that the moving the horse does needs to be the right kind of moving. Therefore, you need to see to the hoof trim and/or shoeing, and also make sure you're not doing the type of 'dressage' we see in competition. I want to know that your horse knows how to carry you and itself straight; I want to know that it's focused and calm when being asked to work; that it works loose; that it goes forward promptly upon light aids; that you know how to turn from the inside hind leg, which guarantees that you also know how to produce a real lateral bend, and are not just dragging your horse through corners with the inside rein. For that type of riding is what gives the horse the arthritis to begin with. Let us know about that, my dear, as much as what you consider 'medicine' or 'supplements', because how you ride your horse is ten or a hundred times more important than any other effect you have on him. -- Dr. Deb

 

 

barbarac
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 Posted: Fri Dec 9th, 2016 04:44 pm
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Thank you for the injectable glucosamine information. That may be the best option. According to ingredients on the powdered Cosequin ASU and your knowledge, it may not be making much if any difference.

Yes I should have said he has some light fluffy bony proliferation near the joint edges, but it is NOT in the joint space and the vet says that is what matters. So now we try and preserve what we have.

Thank you for the reminders on movement and carriage.
Very glad to have found this forum.

ruth
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 Posted: Fri Dec 16th, 2016 12:52 am
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Have been prescribed Cartrophen in the UK (£100 per shot) as weekly injections for similar situation. Doesn't seem to have made any difference to swelling of hind fetlock/lower canon, but horse not lame at walk. Am building up walk excercise, no trotting yet. Not arthritis diagnosis but torn collateral ligaments.

ruth
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 Posted: Fri Dec 16th, 2016 03:12 am
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Also prescribed expensive veterinary daily oral supplement of chondroitin sulphate, glucosamine HCL and MSM for 'maintenance of healthy cartilage and joints in horses'. TheCartophan is not licensed for horses, only dogs, to reduce inflammation (had to sign a consent form) but is apparently routinely used in the UK. Not sure if should continue to use oral supplement containing chondroitin. More concerned about bringing horse gently back into work without aggravating collateral ligaments.

barbarac
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 Posted: Sat Dec 17th, 2016 05:13 am
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My vet said inflammation was the thing to concentrate on getting down quickly, so that the joint was not constantly trying to stabilize itself. The best thing I did that had amazing effects was shockwave therapy. Sound waves that help to organize the scar tissues and it helped greatly at decreasing swelling. Wished I had found it sooner in the process . His had tears/holes as well on both sides. Fetlock will always be larger and weaker but it is scar tissue in the ligaments. He runs, bucks,kicks and rears and is happy. He will be tight if he stands still long periods or lays down to take naps. He needs some time to get the stiffness out, but he is a trooper and stiffness will be expected after periods of rest. Everyone including the vet said his recovery is phenomenal as he had a tremendous sprain in that fetlock. All the best to you and there will be ups and downs but take it a day at a time and don't look too far, just be glad for each day they are feeling good and moving easy. And get that inflammation down:)

ruth
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 Posted: Mon Dec 19th, 2016 01:11 pm
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Thank you Barbarac, may be more complicated situation though.
My horse was kicked on the hock/upper cannon early in September, vet said superficial, did not need xrays, so I hosed, walked, restricted turnout, hosed, hosed some more, it turned into swelling round the fetlock joint, vetwrapped and hosed, then vet discovered high white blood cell count, horse put on antibiotics,very slight lameness when vet asked me to lunge him - and slight lameness after flexion test, next morning both hind legs and one fore swollen and horse very sore on them, vet diagnosed lymphodoema, changed antibiotics, horse colicked on new antibiotic, took him off that, walking and hosing and vetwrapping of swollen legs, swelling reduced on turn out and wrapping, until just slight swelling on original kicked leg fetlock overnight stabling, vet xrayed, found torn collateral ligament at fetlock. Horse is now finished on weekly injections of Cartophen (really why I posted, wondering if anyone had any experience of this drug) - am starting to give him half an hour a day hacking or leading on steady going, but the slight swelling is still there, despite the drugs etc though no lameness evident (not pushed him to prove that)and the swelling is reduced after exercise.
Any advice on rehab, as the swelling is long standing now.
Not sure what mechanical reduction therapies would work at this late stage.

DrDeb
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 Posted: Mon Dec 19th, 2016 02:50 pm
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Barbara, exactly where is the swelling on the hock? -- Dr. Deb

ruth
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 Posted: Mon Dec 19th, 2016 04:49 pm
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It's Ruth, Dr Deb, and the original kick (by unshod horse) was to the side of the hock and side of the upper cannon bone.
The whole leg from fetlock to upper cannon was subsequently swollen but reduced by hosing and wrapping, leaving swelling to fetlock and lower cannon.

This was beginning of September; since then he had mysterious sudden swelling in 3 legs which they thought was lymphodema, this has now resolved, leaving the original kicked leg with swelling to just above the fetlock joint. You would think maybe windgalls in an old horse,but he is an 11 year old pure lusitano who has always been clean limbed. It is slightly warmer than the other fetlock joint, even when brought in from daily grazing, did fill up at night stabled, this has lessened but is still there. I feel the Cartrophan, 4 x weekly injections, have not really made any difference.

ruth
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 Posted: Mon Dec 19th, 2016 04:51 pm
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PS, sorry it's Cartrophen, 10 ml injections. The xrays revealed no damage to the original kick sites.

Thanks. Ruth

DrDeb
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 Posted: Tue Dec 20th, 2016 10:57 am
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Ruth, can you tell me what was the quality of the original swelling that went all the way from the kick site downwards? In other words, more like loose and water-ballooney, or more like denting a cheese? Or very hard, more like bone, but then degenerating into a looser or squashier feel?

And what is the quality of the remaining swelling just around and above the fetlock? -- Dr. Deb

Kuhaylan Heify
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 Posted: Thu Dec 22nd, 2016 07:55 pm
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So Dr. Deb the injectable Glucosamine you mentioned, how does that work. I'm wondering about its use for myself as well as my horse. When I was young I used to run for cardio fitness, and now I basically cannot. I can manage a kind of shuffle for 100 yards or so. The arthritis is in my hips and illiopsoas as well as the bursas. The horse has arthritis in his right front forearm which clicks when I lift it to do his Pauline stretches rotations.
best
Bruce Peek

DrDeb
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 Posted: Thu Dec 22nd, 2016 11:48 pm
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Bruce, it is illegal for someone who does not hold an M.D. degree and license to prescribe anything for a human. Whereas it is legal for the OWNER of a horse to give the horse shots -- either intra-muscular (IM) or intravenous (IV) -- it is not legal to give even an IM of any substance either to another person or to oneself. In other words, you will be very foolish if you try to self-prescribe or self-medicate. Go to your doctor and discuss your symptoms and your possible needs and options for treatment: that is the one and only way. It is possible that your doctor will see IM injections of glucosamine hydrochloride as advisable for you, in which case, the doctor or nurse practitioner will inject you. Your insurance may or may not cover this. If it doesn't, it will run you upwards of $150 per shot.

As to arthritis in the forearm: impossible, because the forearm is a bone and not a joint. Ditto the iliopsoas, because it is a muscle, not a joint. Arthritis is a disease of joints. If you're hearing a clicking sound when you pick up the horse's front leg, it's most likely caused (like all clicking sounds, i.e. from the hocks) by soft tissue snapping over a bony projection, possibly exacerbated by swelling (fluid or gas) in tendon sheaths. Generally these all derive from errors in the hoof trim. The only way to diagnose arthritis (or arthrosis) in or around a joint is by XRay, so if you really think that's what you've got, then I would advise you to order XRays of the horse's carpal joints (his "knees") and the metacarpo-phalangeal joints (his "ankles").

Might behoove you to come down and join in on our Farrier's Special anatomy class, Bruce, to get some of these things straightened out in your mind. We'll be holding it not too far from you, at our own lab near Turlock, January 27-29, and you can enroll now that we have opened the enrollment to the general public. See the thread above in the main list for details. -- Dr. Deb

ruth
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 Posted: Sat Dec 31st, 2016 02:48 am
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The original swelling was squishy and went down after say 30 minutes cold hosing. This swelling gradually reduced and sank down the cannon bone to above the fetlock, around it and below; this reduced on exercise. I measured the widest point of the fetlock just before the vet xrayed after standing in all night in the stable and after bringing in off the field in the afternoon, not very scientific but the difference was 1.5 cm. This was in mid-November. The swelling that remains round the fetlock (actually just above it) is soft and squishy, and seems to have settled to a constant.

Still just walking him, he seems ok but not pushed it to test any further. He canters across happily to me in the field. Vet's last flexion test in November showed slight reluctance to trot off/favouring that leg.

Am seeing vet next week to return some unused needles, is there anything relevant I should ask him please? Thanks again for all your input.

DrDeb
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 Posted: Sat Dec 31st, 2016 04:53 am
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Ruth, what I was probing for by asking about the quality of the swelling was to ascertain whether you had cheesy edema -- classic sequel to a broken bone. If the kick had produced a hairline fracture, sometimes those do not show up on XRay. However, your description does not indicate cheesy edema (cheesy edema has the "tight" quality of Edam cheese, so that if you press into it with a finger, the dent stays a long time).

What you seem to have is, just as you say, a remnant of earlier swelling, which was larger; and the quality of it is loose like a water-balloon. This is the sort of thing that occurs when a few blood vessels get squashed by the impact of the kick, and yes it does tend to sink down and then accumulate at the ankle. So what you have is just some bloated tissue which is an accumulation of broken cells and their contents. The contents of broken cells are caustic and irritating to surrounding cells, so the body imports watery serum to the site in an effort to wash the stuff out.

The swelling remains for a fairly long time because there are a lot of fairly large chunks of the broken cells, and these are just physically too big to be picked up by the venous return system. They are instead picked up by the lymphatic system, but the lymph system works a lot more slowly than the ordinary circulation and is, by the way, highly dependent for its efficiency upon how much and how vigorously the horse is permitted to move -- the more he moves, the quicker the lymph system will slosh along.

Meanwhile, the continued presence of excess fluid has a tendency to distend the intercellular spaces which it occupies; it stretches the tissues and this may take years, if ever, to reduce. Unless you are seriously into "halter" competition I wouldn't worry about it much, though, as it has little to no functional significance.

Any remaining deficit you're getting on vet flexion exam is because the horse still to some small extent feels the bruise that the kick caused. Undoubtedly there was originally a "blood blister" on the periosteum of whatever bone of the upper cannon or tarsus where the kick was focused; or more than one, depending if the kicker was shod with caulks, and just how the blow landed. A "blood blister" is the result of blood leaking out of tiny blood vessels lying between the periosteum and the bone shaft that got crushed when the horse was kicked. The blood leaks out between the periosteum and the bone, pushing the periosteum up into a blood-filled bubble. These hurt quite a bit and are slow to resolve.

I don't know what else you might ask your vet about -- you might discuss the content of this reply with him or her, and ask their opinion about how long the horse should continue to be rested. My take on this would be to ride him as soon as possible, as this will certainly help reduce swelling of any nature and in any location. The test of whether a horse is lame is -- whether he limps. Therefore, if you ride him at a walk and all is well, proceed to the trot. If you ride him at a trot and he gets no worse, then ride him at a canter. This is the same way that the vet knows whether the horse is lame: whether he limps. You have to ask the horse in order to find out! Cheers, and happy New Year -- Dr. Deb


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