Early this morning, I shuttled Gogo up to see Dr. C for our two-month ultrasound, which I suppose was technically a one-month ultrasound seeing as we also went back last month to get cleared for trotwork. The ultrasounds looked great then, but I was obviously worried about this past week's edema and wasn't sure what we were going to find. Just like the last recheck, the edema was magically gone when we got to the vet. How about that. We jogged her out in a straight line on pavement, and she was very sound - exactly the way she has been, a little uniformly stabby on both hinds if you were looking to fault something. Dr. C wanted to see her on the lunge, and I reminded her that Gogo hadn't been lunged in 10 months and I couldn't guarantee she wouldn't be ridiculously wild and stupid. Bless her lil' heart, she somehow managed to hold it together and behave herself perfectly, even though she did get that wild head shake a few times. She clearly wanted to be fresh, and I was very proud of her for keeping it sensible!
Back in the clinic, Dr. C didn't think we even needed to look at the tendon on ultrasound, but I asked if we could anyway just for my peace of mind. Lo and behold, it was gorgeous! Not a question in sight. The excess edema was just, well, edema. As we've always known all along, the legs are never going to be normal by any means, and sometimes they'll do weird things, like fill unexpectedly. As long as the fill goes away with movement and she's sound, it's all right. Phewwww.
We did choose to go ahead and medicate the hocks. There has been interesting dicussion on all ends concerning the original injections last August and their possible (probable) link to the original injuries, and I was asked if I would ever consider doing them again if need be. The clear answer in this situation was yes, but more wisely than before. I didn't appreciate how much better they made her feel before, and even though she had her few days of downtime as prescribed by the vet, we went right back into hard training and showing. Given her newfound comfort and freedom, she was using those limbs harder than ever, and with that increase in stride length and suspension came a subsequent increase in tendon load. What I suspect possibly happened was that the tendons had minor microdamage happen to them, just because we went on with our heavy training load as planned with only about a week of rest and light work - in normal situations, this was enough, and the tendons would have strengthened and rebounded in a normal fashion. Studies have shown that the way tendons strengthen is through microdamage on a cellular level, often stimulated by work on hard surfaces, such as pavement. This is why eventers tend to spend a lot of time hacking on paved roads at low speeds for long distances - it turns tendons into iron over time. However, in my case, while she may have had iron tendons given the tons of very careful conditioning I had done over the course of the previous year, she then had a new level of motion in her limbs to deal with, and wasn't through with compensating yet by the time we got to the AECs given all the hard stresses placed upon her in the three weeks prior. In her rather extreme case, this potential microdamage had to go to a show and cope with some wet and very slippery footing, then had to endure bouncing in a trailer for two days on the way to the AECs, and then during a very minor slip on XC had no strength left to rebound. If you've not seen the video of XC where we actually caught the slip on tape, see if you can spot it:
There is no reason a carefully fitted up horse should have had serious damage from a tiny slip like that. Which is honestly why we think it all tied back into the hock injections, done less than a month out from the AECs. I think it was a horrible time to do them, in retrospect. But not one single person pointed this out to me beforehand, and not one single person said 'told you so' afterwards. Everyone looked at me blankly when I explained, and then agreed that I was right, and they hadn't thought of that before. Thank you Daun for being the only one who had sense enough in your head to be like, "well duh." Had she not slipped at the AECs last year, we wouldn't be having this discussion. She more than likely would have just gone on with her bad self, and nobody would have thought twice about it.
Let me make this perfectly clear. I am ANTI-injection. Absolutely, without a doubt. BUT, I am not above refusing a needed treatment for my horse just because I don't like it. I might hem and haw over it, but at the end of the day, it's been almost a year since the last injection. She was starting to get uncomfortable in the right hock, and aside from turnout (which we can't do), there wasn't any other base I could cover. You name it, I'm currently doing it. It sucks that she had changes in her hocks. It sucks! But I can't ignore it and just hope it doesn't bother her too much, just because I don't like injections. A horse in pain will compensate for it. A compensating horse is putting stress on other places it shouldn't. A stressed limb will eventually fail. There is no way to expect her to have a proper rehab if she's not completely comfortable during it. How would you like to be doing PT for your Achilles tendon if your knees were sore? Woudn't get too far would you?
Unlike last year, there was no excess fluid in the joints. There was also not the same morality issue at hand. I've come to terms with what I need to do for this mare in order to keep her comfortable, and that's how it is. She needs to be comfortable in order to complete this rehab. I'm not trying to make her jump higher, run faster, or score better in dressage. I'm just trying to make sure she's where she needs to be, and that she's happy, and that she feels good. At the end of the day, that's what it all comes down to. Injections might be an American sickness and a seriously damaging crutch, but in a case like Gogo's, when there is actually a medical need, they have a place. Trust me, though, I have PLENTY of ugly things to say about them and their rampant abuse that I see every day.
Three days of treadmilling and coldhosing are in Gogo's forecast for the week. Then we go back to slowly building her under saddle work back to where it was. And then.... WE CANTER. YES!
Gogo says, man this coldhosing thing is crap...
.... I'd rather be doing some of this please!!
After reading your points, it makes a lot of sense to inject the hocks as she begins conditioning.
ReplyDeleteI wonder if the horses at the Spanish Riding School need their hocks injected as frequently as other performance horses. Or if there is a particular breed that consistently does not require injections. Is there something that could be done differently through the course of a horse's training to prevent the need for injections, or is it inevitable wear and tear? I bet you have thought a great deal about these questions already.
I go through the same thoughts with my 100 mile horse regarding the injections. The turning point for me was realizing that just because there are changes in her hocks doesn't necessarily mean I've done anything wrong. In more cases than not the hocks are going to do what Rey hocks are goig to so regardless of training or amount of work. The only reason some horses seem to be able to sit in their pen as happy as a clam is because it's either sublte enough the owner doesn't notice, or the owner is in a sport and the changes are minor enough that they can just do really long warm ups. I asked my vet whether there was ANYthig I could have done different and he said nope. Funny, I can sit at a vet check now and watch the horses trot out and spot the ones that might have sore hocks. Invariably it's the owners that refuse to consider injections. I never thought I would be injecting either, but after seeing how insanely different she was afterwards, how can I NOT give her that kind of releif? She's no where near retiremet age and she loves er job. Not to mention this would get worse if she just sat there. The decision has become easy to me- she can sittjere in pain and not be worked, or be in pain while being worked OR she can be comfortable and stay in work which will help her hocks in the end anyways.
ReplyDeleteIf I understand the issue right, it's not really the prevalence of injections that's the problem, it's the prevalence of bad training methods that lead to injections a few years down the road. There's little sense in protesting the overuse of injections by holding back when you've got a horse that needs them (assuming less invasive therapies have already been tried) - the damage is already done, for whatever reason, so go ahead and fix it.
ReplyDeleteWe can all protest by training our horses the best we can, regardless of fashion. If they end up needing injections anyway, well, they were invented for a legitimate medical reason! Just because a large number of people abuse them doesn't mean that *you* are abusing them.
I tried injections with my mare, on the advice of an overly pushy vet I never liked, and will never use again. The cost was staggering, the actual procedure was hard on her (she doesn't tranq all that well, she fights it) and all we got out of all that was her being even stiffer than before. Basically, injections epically failed on this particular horse. My local vet's theory (after taking x-rays, which Pushy, Overly Invasive Vet didn't even bother to do before injecting) is that the changes in her hocks are so advanced that anything you inject in there is just going to blow through the joint and not do any good. It's great that the injections appear to help Gogo, but obviously that's not the case with every horse.
ReplyDeleteAs I was talking with a third vet about Sofie's hocks, she actually said it is really uncommon to find a horse WITHOUT arthritic hocks, which, frankly, I find disturbing. I think a lot of it comes down to training. Everybody wants it perfect RIGHT NOW these days. Horses get pushed too hard, ridden incorrectly, and broken down. All it took to undo your careful, conservative work with Gogo was a few months with Crazy Trainer. Sofie was eight when I got her, and she had at least three owners before me. I don't think she was ever ridden correctly or carefully, and unfortunately she paid the price.
From what I've read is that EVERY horse (although there are some very special exceptions.....as with all medical stuff) go through hock changes starting at 7-10 years of age. It's NORMAL to see hock changes. Now whether those changes actual lead to a level of discomfort is highly individual for each horse. Horses that sit in a pasture and are never used will go through hock changes that may eventually lead to fusion. Yes, bad training can make it worse, but to some degree all horses are undergoing hock changes regardless of whether they show pain or not. Sometimes the change can be very very sublte and the horse still shows discomfort. My mare's hocks xray as "clean" for purposes of a prepurchase exam, however she's noticably uncomfortable so I chose to do injections.
ReplyDeleteI think when deciding to do injections it is important to go to a top rated clinic and a specific vet that is known for doing the injections WELL. It's easy to screw it up and then it's $$ down the hole because it won't do anything past the short actiging pain killer.
I'm NOT about invasive treatments AT ALL and I'm all for management techniques to reduce the need for invasive treatments. But sometimes it's needed with ONE BIG CAVEAT....
One of main questions I asked my vet was: By injecting her hocks, and making her comfortable, am I contributing to long term harm and break down? The answer was absolutely not - the changes are going to take place regardless of whether i do the injections. The question is - how can I manage the pain and inflammation as the changes progress - riding will help and injecting her hocks will allow her to be ridden comfortably and therefore keep her sounder and more comfortable for longer.
I don't know why it is, but hock injections, particularly to the point where they are seen as a 'normal' thing to do, are in my experience definitely an American thing. In the UK I have managed exactly three horses with hock injections. Same when I worked in Europe and the same in NZ - I never met a single person there who'd given their horse hock injections. I think most vets and owners here are a lot more likely to look at feet, fittening, and supplementation before taking the jab route.
ReplyDeleteThe three in England were an 8 year old Advanced dressage horse, after a fall and subsequent joint damage, an imported from the US 12 year old WB mare, and a 22 year old TB event horse. The 8 yr old did not improve significantly with the injections. The mare's new owner took her off the injections and successfully managed her with turnout, specialist foot care, supplements and not working her on deep or hard ground. The eventer had had a course of them in his late teens when he began to have arthritis problems on the left and then again at 22 with the right hock. He missed the better part of a season but returned to light competition. I just spoke to his owner the other week, and she hunted him once or twice a week all last winter.
Which is a very long way to say I think they are massively overused in the US, but they can be a useful tool in managing soundness problems.
FD, quick question: when you say "course of injections", what does that mean exactly? I'm looking at doing once yearly intra-articular injections, if I feel she needs it. But I also give intramuscular Adequan as well. (And an oral supplement, Cosequin ASU.)
ReplyDeleteIn the 22 yr olds case, there were arthritic changes in his lower hock joints, so he had 3 injections of hyaluronic acid and a steroid (owner couldn't remember which) in the left, discontinued after fusion was complete, with managed light work during the period. Same again when he began to have problems with the right hock - at this time he was boarded with us and he had 2 injections of depo-medrol and HA. It took about 6 months from onset to stability. During that time he remained in light work, (mostly hacking on the roads) and lived out 24/7 in a confined turnout with a pony as companion.
ReplyDeleteThe mare that we discontinued injections on had arthritic changes in her left upper hock. She was being given dexamethasone, intra-articularly, which provided some relief, but would wear off within 6 weeks.
We took her shoes off behind altogether, brought her heels up and shortened her toes. She went onto glucosamine and chondroitin supplements. It was debated whether to try her with IM cartrophen injections but she improved enough with the above that we decided it wasn't necessary.
The dressage horse had damage to the left hock joint capsule and the cartilage of the tibiotarsal. (He had a bone scan.) He was given triamcinolone which did not have more than an initial therapeutic effect. The owner decided to try Dr Green therapy, aka turning him away for a year so I don't know what his long term outcome was.
It occurs to me now that I've said all that, but I don't recall whether you've said which hock joint exactly there is a problem with?
In my experience lower hock joints have good prognosis, but upper are more problematic. I've seen a whole bunch of horses with lower hock problems, (commonly lumped together as bone spavin) and unless they are in the process of change, they are generally very manageable without steroid use.
FD,
ReplyDeleteInteresting! It's the lower joints we're talking about here too. If we were talking high-motion joints, I'd probably be retiring this mare. As we stand today, Gogo is on an intramuscular series of injections of polysulfated glycosaminoglycan, which is helpful. She's also on an oral glycosamine/low molecular weight chondroitin/avocado/soybean unsaponifiables oral supplement, which is also great. Honestly, if she was turned out 24/7, or even 12 hours a day, I wouldn't be looking at intraarticular injections at this point. Unfortunately she's probably stuck in a stall for at least another month, maybe even more, and that is awful for joints, hooves, brains.... you name it. So in goes the fancy Hyalovet, fancy depo-medrol, fancy Predef 2x, and here's a bill for $600.
It is seriously interesting to compare what we do with horses here for therapy (rest, injections, invasive treatments) versus a lot of places overseas (turn them out and that's that).