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In Loving Memory...
~ Gogo Fatale ~

6/2/01 - 10/11/11
~ Forever the Marest of Them All ~

Thursday, June 11, 2009

Let's Talk Hocks

First off - still no word from Groton House yet. The suspense is killing me!! But in other good news, both my checks for Riga Meadow and for Area Championships were cashed today, so that means I got into both of them. Yes!

Now, here's the topic I worry about ALL THE TIME but still don't have any solid conclusions about, so advice and comments are all appreciated. As you may or may not know, last year in the early summer, Gogo started doing little things like chipping fences and taking rails in competition. She was never really lame per se, but there was something weird going on. Something wasn't right. I took her to the Equine Specialty Hospital in OH, and via flexions, blocks, and radiographs, we isolated the problem to her right hock (flexed 1 out of 5 on the lameness scale, so it wasn't bad!). I had one of two options, the first being hock injections, and the second being very proactive and less invasive maintenance. I opted for the second choice, seeing as she had only just turned 7, she was only showing BN, she wasn't really lame, and there were a lot of options to keep her comfortably going. I am anti-injection when I can be. So, we started her on Adequan and Cosequin, and the chipping and dropped rails disappeared. Her dressage work improved, and her overall condition and comfort level went way up.

Fast forward to now. She's in much harder work, and I worry about her comfort level. She's still on the Adequan, and we've switched to the Cosequin ASU, which is a good product even though it's damn expensive. When I put her on the lunge the other day, she looked outstanding. She's jumping really well, hacking really well, and doing dressage work really well. But there are little, subtle things that worry me. Today, her first day back to dressage work after the chiro adjustment on Tuesday, was similar to the last time she got adjusted in that she needed to figure her readjusted body out a little bit. She was very good, up until I did a few canter lengthenings on the left lead. She seemed a bit hot to trot after that, and I did a simple change across the diagonal onto the right lead. And, well, we kind of blew up a little. She didn't go crazy really, she just sort of did the head in my lap thing, and stopped steering for a few. We eventually got a few decent strides and then went right back to trot, but it was interesting that it was on the right lead, her generally weaker side (and mine too). When she was adjusted, through the applied kinesiology Dr. Amery found no hock soreness (he can tell where the horse hurts through certain points in the body, and it seems to be spot on as far as I can tell), but he need to make adjustments to her left SI as opposed to her right - compensating for the right hind? Who knows. The other thing she was doing today, very consistently, was when we would go to halt, she'd leave her right hind behind her, which isn't abnormal, but whenever I'd ask her to move that leg forward in the halt, she's comply, but she'd just rest it instead of bearing weight on it. Unusual. But then again, the most sore spot he found on her was beneath where the cantle sits on her right side, so maybe she was still sore from having that adjusted? Or here's one more option - I tend to sit crookedly to the right, and I'm very much so in pain and in need of an adjustment myself, so maybe it was me causing the crookedness? I don't know. Also though, when she was in the crossties, 90% of the time she was resting the right hind. She tends to rest both hinds a lot when standing around, but is that relaxation, or is that discomfort?

She's not lame. She's jumping really well. She's progressing fast in her dressage work. But I still worry. I want to delay hock injections for as long as humanly possible, just because a) I hate being so invasive b) anytime anything goes into a joint there's risk of infection and DEATH and c) long-term use of steroids can lead to cartilage degradation. There's a very good article here on joint injections and joints themselves, and there are bits of information on there like this:

"The lower motion joints of the hock are unique in that they are a major origin of subclinical performance issues (commonly sore back syndromes and poor movement and push from behind), yet are not essential for movement of the hock. For this reason they can be viewed in a radically different manner than other joints within the horse. In fact, if these joints were to magically be removed from your horse, they would maintain their full athletic scope and ability without the downside of persistent, low grade discomfort which often accompanies arthritic change.
For this reason, long term comfort of the horse and relief from the arthritis is the primary goal of lower hock joint treatment, NOT continued motion and flexibility of these low motion areas. This is a very important concept to grasp as joint comfort and treatment for joint function are not necessarily the same. Granted, high motion joint treatments such as Adequan, Legend (intravenous hyaluronic acid), intra-articular hyaluronic acid (HA) and low dose, short acting steroids do play some role in creating comfort. However, all of these drugs are aimed primarily at restoration of a more “normal” joint environment. The primary goal being preservation and regeneration of healthy cartilage. In lower hock joints we often take a different approach. As these joints are not necessary from athletic performance, their more reliable comfort becomes the primary goal somewhat at the expense of the cartilage involved. For this purpose, long acting steroids (the most potent anti-inflammatory available) are used."

Now, from this you can derive a few things. The lower hock joints are not important in a horse's mobility directly. Horses with fused lower hock joints perform effortless and, more importantly, pain-free. BUT, the road to a joint actually fusing is a painful and long one. So, the primary concern of a joint like this isn't to maintain mobility, but to maintain comfort and minimize inflammation. By injecting the joint with powerful steroids, you can dramatically reduce inflammation and drastically increase the horse's comfort, BUT you also take the risk that the cartilage will sustain gradual and permanent damage. Osteoarthritis doesn't heal. It doesn't go away. It's there for life, and it can only get worse over time, which is why the diagnosis was horribly depressing. There's no reason Gogo won't be able to go on and lead a rich and fulfilling competitive life, but it needs I need to be careful.

And careful I am. I use bute before and after hard workouts. I wrap, cold-hose, and use liniment and poultice regularly. I maximize turnout time, encourage movement, and provide lengthy warm-ups and cool-downs. She's on Cosequin ASU, and gets regular Adequan (and Pat says I can have some of her Legend too). I rarely jump her over 3' at home, and I rarely jump her more than once every two weeks. I don't lunge her anymore (well, there's a more complicated training issue behind all that but regular lunging also compounds the arthritis issue). I handwalk all the time. So is she still uncomfortable on some days? I don't have an answer for that. I honestly don't know. It could be this, it could be that. She's going so well that I have no reason to suspect hock pain, but when she does things like rest her right hind a lot, I still worry.

Shannon and I brainstormed all afternoon. Joint injections would mean relief if she is feeling discomfort. They might also add to her long-term soundness and performance. But, they also might contribute to her long-term unsoundness. I feel as though they are inevitable, and I'm okay with that - it'll probably have to happen next spring. But for now, we came up with some other ideas - using HPQR gel on that hock, using poultice on that hock, continuing the use of bute before and after a hard workout day, possibly looking into Surpass, adding Legend to our arsenal, and looking into the Back On Track hock wraps. I've heard nothing but totally positive things about their products, and we have a horse here who has the mesh sheet and the leg wraps. It does seem to make a difference. I'd rather try this than traditional magnets, because I dunno how I feel about magnets in all honesty. Back On Track, on the other hand, seems legitimate.

I just want her to be comfortable, happy, and able to perform her job pain-free for as long as possible. I don't know if she's achey, but I sure know that I myself get pretty ouchy on some days. She's not lame (and is moving better than ever really), is jumping great, galloping well, and hacking perfectly. So am I just creating bigger issues than need be? I don't have any idea. But I do want to avoid invasive actions until I feel that what I'm doing isn't helping enough.

Any other ideas? Opinions? Input?

PS - I apparently got some special award from Mystic for being the Area I Adult Rider with the second lowest score. Dunno what it is, but I'll set you know once they send it to me in the mail!


Beckz said...

To be honest, you may have a touch of the worried mum syndrome. As long as she is performing I don't think you should worry as you are doing everything in your power to help her. She will make is obvious when she is uncomfortable, like she did originally.

I have also heard really good things about the back on track and when my friend blew out her knee, the back on track hock boot on backwards helped her a great deal.

Anonymous said...

I don't do joint injections - for the reasons you mention - but many people do. I think injections are more for people - so they can keep competing and rationalize that the horse is more comfortable - than for the benefit of horses. As you suspect, minor hock discomfort can lead to follow-on effects - stifle, sacrum, back, etc. You seem very sensitive to what is going on for her, which is really good. Horses that jump extensively often go on to develop some hock issues - and it could be that she's starting towards joint fusion on that side.

I was also interested that you identified your own position as potentially part of her problem - this can be really true - we have our own crookednesses, and the horse can compensate for that, and then we compensate for the horse, etc., etc. If you can maintain a neutral position, that may help her.

I think you'll know when you can push and when to back off - you seem to be very smart about such things.

JW.BW said...

I started having problems with Sydney's right hock when she was about 6 1/2 (she raced, so I wasnt too surprised). I did injections, they did work, but it was short lived and it made me so nervous. I had her on cosequin for about 6 months before finding Recover EQ, this is a FANTASTIC product, it made all the difference in the world for her when I had her on it. She is a pasture ornament now and isnt doing the jumpers, so i took her off of it until I start riding again, but anyway, they now have it with HA as well and it really is amazing. Bonus is that it is even cheaper then cosequin... It might be worth trying for you, like I said, it really worked for Syd, so much so that I stopped her injections.|Store_ID=Equine

Another nice product is Tendonil, my old trainer Olga swore by it. You use it before work and it helps loosen everything up. I used it on syds back, hocks, and stifles, it also made a difference for us.

Good luck!!

Sarah said...

Well you *may* have a touch of the worried Mum syndrome, but I also believe that there is nothing WRONG with that and trying to make your horse as comfortable as you can!

It sounds right now you are obsessing a bit about her resting her leg on the bad hock? Well ALL horses have to rest their legs. Has this become more pronounced? Is she doing it more often? Those would be great indicators, but you have also increased her workload significantly, so who knows if she's just more tired?

I personally would probably keep an eye on it and not do anything more. Also, if you *were* to do anything I'm not sure I'd go with the BoT wraps. Here's why - inflammation creates heat....the BoT wraps also "create" while it may soothe her soreness a bit, it may not get rid of any inflammation. I personally would probably do the whole icing, poulticing route. My own (human) chiropractor told me that ice is for joints, heat is for muscles.....I find that VERY true when I am in pain (if I feel I need ice it's almost ALWAYS because my back is out of whack). I have Ice Horse boots and really like you might just try something like that first.

Jana said...

I think it's wonderful that you do so much to help Gogo feel comfortable while she's achieving so much!

You might want to consider sports massage for her, following her chiropractic adjustments. Just as human athletes are increasingly recognizing the benefits of sports massage (article on sports massage for people), so are we realizing the benefits for our equine athletic partners. Equine massage relieves tension and muscles spasms, improves circulation which promotes more rapid healing of injuries, enhances muscle tone and increases your horse's range of motion, increases potential performance and endurance, reduces inflammation and swelling in the joints so that pain is relieved, increases the production of synovial fluid in the joints, lengthens connective tissue and breaks down/prevents the formation of adhesions.

And, it just plain feels good, without any risk of damage/pain/etc. :)

Sarah said...

I wanted to add - hopefully you have her on a schedule with a chiropractor? Anything out of whack can cause them to compensate, which may put more undue stress on the hocks. I'm sure you already do that, but just wanted to make sure for others who might read the blog ;)

Albigears said...

I second the massage idea. Even just a diagnostic massage can turn up tightness in places you wouldn't think of.
Before you do anything as drastic as injecting her hocks, why not rule out your 'pain' issues first? I would make sure that YOU are as pain-free, supple, and balanced as you can possibly be.
Maybe get an adjustment, a massage, and whatever else needed to be done to feel as strong and as centered as possible. Think of it as helping Gogo.
Then ride for a couple of weeks so her body has time to adjust to your new body.
Of course I am not blaming you for her possible issues! Having a horse-massage background, I've found a lot of soreness diagnosed as other things was just because the rider was a tiny bit off this way or that way, or was doing something unconsciously that put pressure on the horse.

Kristen said...

I think you might be over analyzing the issue some, but I understand and know from experience. My horse has arthritis in his hocks, and there have been some changes in his right hock over the past 2+ years. I could go on and on and on about the whole thing, but the shorter explanation is our vet at the time (who passed away from cancer not too long ago) made the arthritis a pretty big deal. Sonny ended up getting two injections, one set in November 2007 and the other in May 2008. I have the records recorded, but I can't remember off the top of my head what was actually used. Anyway, now we know that his arthritis is actually more mild than we were told, but I don't think we regret doing the injections at all. The signs during fall of 2007 went on for longer than they probably should have. I was struggling a little with learning how to ride him so his resistance in dressage and tendency to get flat, fast, and run out at fences were read by trainers as disobediances and miscommunications between me and him. Even when my dressage trainer got him she would sometimes end up getting in big fights with him. He would throw his head up, back up, and be very resistant about accepting the bit. But...he would also have better days and be okay. We usually got mid 30s in dressage which isn't too bad. Last October, he had been doing fine without injections, and we had the awesome Chris Newton from Rood and Riddle do a lameness examination. He did a very INTENSE exam that lasted more than an hour. Sonny was sitting back on his butt when Chris was flexing him! He is a drama queen though. I believe he actually flexed a 2 on his right hock, and...ugh...can't think of which fetlock it is, but I'm pretty sure his left front fetlock flexed a 2 as well. His left hock flexed a 1. Chris did xrays on both hocks, the fetlock, and reviewed his old xrays. His answer was that we were worrying too much! He said Sonny was perfectly fine without injections. We need to be careful about jumping too much and footing. He also said he thinks people are overdoing their gallop sets and recommended lots of canter work in the dressage instead. I think he thought some trot sets were necessary, but that for Training and under...even Prelim and under...riders didn't need to be doing too much speed work. We asked him about Surpass, and he thought it wasn't necessary. I wish I could remember his exact explanation but basically he said some people are going to see great results and others none. He said the best thing is ice and some bute. And for oral joint supplements he said he personally thought that nothing on the market right now is going to make a huge difference but Cosequin ASU is the best bet if you want to supplment with something. We have Sonny on Cetyl M, but that is just our personal choice. He said the thing with joint supplements is that companies can list ingredients and then actually take stuff out without changing the label to cheapen the cost! Don't know if that is completely true or not.

Beth said...

Have you considered acupuncture?

Ambivalent Academic said...

Hi - First time commenter though I've been following you blog for a while. Thanks for letting me live vicariously - I can't afford to keep a horse while I'm in school. :(

My $0.02:

1)Resting/leaving the RH behind as well as the blip in your diagonal are very very likely to be the chiro adjustment. Realigning the skeletal system causes (temporary) muscle soreness/weakness as everything figures out how to work efficiently in the new/better alignment. You probably already know this but it sounds like you're looking for some reassurance. Any imbalances that you may have can also affect this - are you getting chiro adjustments? Also, for people chiro adjustments tend to be tiny and frequent until everything is back in alignment...for horses we tend to go big and rarely (probably because of the expense)...but it might be a thought to do three weekly adjustments in a row if you can afford it. (I know, I know.) With both myself and my own horses I've found that the biggest adjustment is often the first to bounce back into its misaligned position, so frequent reinforcement until it stabilizes can help. Keep in mind that this might prolong any mild discomfort in the short term as above.

2) Magnets. Meh. I'ma scientist (and therefore a skeptic) so feel free to take this with a grain of salt. I've used them on my horses out of desperation, but I am utterly unconvinced that they are anything other than an expensive scam. The "scientific principle" behind how they are supposed to work is unsound. As I understand it, the idea is that magnets change the electromagnetic field that the horse produces (we all produce one), and that this stimulates blood flow to the area.

I am not sure that I've seen any convincing evidence of increased blood flow, and as far as I can tell the strength of the magnet with respect to the strength of a body' EM field...well, there just wouldn't be much disturbance if any. So I don't think that they do what the manufacturer's claim that they do.

That being said, I know a lot of people who swear by them and say they make a noticeable difference in their horse's way of going. The power of suggestion may be all it is, but it's a powerful thing. If you believe that your horse will go better it probably will, magnets or no. If it takes expensive magnets to achieve this, I say that's fine. It certainly can't hurt. I just prefer to spend my money on another chiro adjustment or massage.

Finally, I'm anti-injections if I can be too, for all the reasons Kate said. My horses always had 24h turnout, and none of them ever required injections. I'm a big fan of turnout for that reason, but of course it's not an option for everyone.

Anyway, I hope any of that is at all helpful. Keep writing - I love reading and good luck at Groton House!

Ambivalent Academic said...

Also - have you considered the Dynamite supplements? They don't retail (you have to get them through a distributor), but I've been very happy with their Free And Easy joint supplement (glucosamine/chondroitin plus a whole host of plant-derived anti-inflammatories). It's cheaper than cosequiin if I recall correctly and my dog who has torn ACLs and hip dysplasia is now running 20 miles/week. Now way has was doing that on the cosequin. Dynamite makes products formulated for equine canine and people. I've used their horse products too and was very impressed.

Kristen said...

Oh yeah, and I forgot to mention while the fact is that Dr. Newton said Sonny was fine without injections for the time they DID help a lot. My event trainer was very skeptical of the whole thing. I only see him once a month at the most so I thought it was a good sign when he said he definitely saw a pretty big difference in Sonny's way of going. He was more "springy" in his jumping and seemed happpier. He did not, however, see much of a difference after the second set of injections. I think there *was* some difference but not as much as the first set in November. So my conclusion is that he probably only needed them in November 2007.

Patricia said...

I second ice boots. I've been bringing a set of ice boots to the barn everyday I ride in a cooler, and I put them on for fifteen to twenty minutes and rub Shorty down with liniment. I've noticed big improvements in his seasmoiditis and reduced fill in his hind legs. I'm sure an icewrap on Gogo's hock would be helpful.

I've used BOT wraps before, and a lot of show jumpers sear by them. Although added heat seems counter-intuitive, I did notice improvement on the horses I wrapped. I prefer BOT wraps to a furacin sweat- less caustic, less irritating, and less messy. I would use then on Shorty if I could trust the BO/M (He who shall not be named) to take them off in the morning.

The USEF is very restricting over the kinds of supplements you can use. Pretty much anything herbal, including MSM and glucosamine, is illegal because they are not dependable like a pharmaceutical. Therefore, I won't recommend any types of supplements because I'm sure the USEA is the same way.


Retraining a Racehorse