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Ask The Vet: Advanced Technologies in Lameness Diagnosis - February 10
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Lameness in the horse is a situation that we, as horse owners, will at some point have to face. Diagnosing that lameness is often harder than treating the condition. Pose your questions for this month's expert, Omar Maher, DV, DACVS from the New England Equine Medical and Surgical Center, regarding the topic of advanced technologies in lameness diagnosis.
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Question: I am looking at buying a Quarter horse for reining. He is 10-years-old and has been shown. His current trainer stated that the horse had an issue stopping big more than three time in a row, which was attributed to arthritis of the hock. This, he said, greatly improved as bones had fused by the arthritis and he now stopped big with no issue? Does this make sense or is this a possible explanation?
Answer: Click To View
Horses with hock arthritis will have a hard time stopping big, and yes if the lower hock joint fuse, the arthritis pain can resolve. Whether or not it is the case for this particular horse is questionable, and the best way to confirm it would be to have your veterinarian take Xrays of the hocks.
Realistically, most horses will go through a phase of pretty severe lameness before completely fusing their hocks, and since you have not mentioned anything of the sort, I have to be skeptical.
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Question: Is "nerving" my 8-year-old gelding an option for permanent pain relief of navicular syndrome in his right front foot? I ride him only on very easy trail rides. I give him Bute on the days I want to ride. Aluminum three degree wedge shoes do not seem to help much and he has a marked limp many days. I am 62 years old, weigh 122 pounds and use an Australian saddle, so the weight he carries is not a problem. He is 15.2 hh. I did not know he had navicular syndrome when I bought him last November. I love this horse and want to keep him.
Answer: Click To View
Having a neurectomy performed on your horse is always an option that is viable. There are risks involved with the procedure and some consequences can be life threatening (about seven percent).
When a horse is nerved, he does not feel his foot, so if for example; he gets a nail in his foot, he will not show any lameness until the infection becomes uncontrollable. With that said, horses that undergo a neurectomy need to have their feet checked daily.
Another major risk about a neurectomy is when one is performed has a major tendon tear inside the foot. Because he does not feel it, if he continues to use his foot hard, he risks the chance of rupturing.
Ideally, before getting to a neurectomy, you would have an MRI or a contrast CT performed on your horse's feet. This way, you know exactly what is the problem (as navicular disease is a broad conglomerate of many problems in the foot from bone issues, to tendon and ligaments issues).
Knowing what exactly the problem is will offer you the option of treating it a more efficient way and will tell you if a neurectomy is needed and if there are any contra-indications for it.
The last report on neurectomies in horses showed 85 percent of soundness a year after surgery, and a mean time of soundness of four years after surgery.
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Question: I have a 12-year-old Quarter horse gelding with lameness in his left front knee. Radiographs were taken and presented an odd injury where the bone was chipped, and the chip modeled (not sure if this is the correct term) itself back, but now there is what looks like bone spurs that shoot off from all directions. The veterinarian has recommended surgery but I am interested if there might be alternatives to surgery, as in pain managament, modern medicine or holisitic. I just want to see him have a pain free life whether I retired to the pasture of light riding.
Answer: Click To View
The answer to your question will all depend on the degree of lameness your horse is dealing with, and how large the chip is. What also will affect the decision is what treatments have been tried so far (joint injections and such).
Surgery will be recommended if there is a chip or large spur that would definitely impair proper joint function. Also, it would be recommended if the horse has stopped responding to more common therapy such as joint injections.
If you definitely do not want to consider surgery, there are a few options to try:
1) Joint injections with Hyaluronic Acid and corticosteroids.
2) IRAP (interleukin 1 receptor antagonist protein) is a product derived from the horse's own blood that help balance the inflammation level and has had good results even in some cases where steroids failed to work.
3) Long term anti-inflammatory medications such as pehnylbutazone (bute) or even Equiioxx (a different type of anti-inflammatory that is not as likely to cause side effects such as gastric ulcers or kidney issue).
You could also contact a veterinary acupuncturist to treat him regularly as they can alleviate pain to some extent.
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Question: I am considering purchasing a reining horse that has a bone chip resulting from a fracture in it's left rear fetlock. The horse is 5-years-old and currently sound. The fracture occurred in its 3-year-old year as a result of getting a rear leg caught in a blanket strap. The horse was put in rest mode until two months ago and was brought back slowly with easy lunging. The mare is in regular training mode now and requires another three months or so of training to be a finshed reiner. The veterinarian that has been involved in the diagnosis and treatment said if it is not bothering her currently then leave it alone and not to worry about removing. I really like everything about this horse but I am generally not a risk taker and I am concerned about future lameness problems. How can you advise me relating to this matter?
Answer: Click To View
This will all depend on whether your mare is truly sound (upon having a veterinarian evaluating and performing flexion tests), and the exact location and configuration of the chip fracture. Some chips do not seem to ever pose a problem, others can do so after a hard training session. It will be also important to ask if the mare gets her joint medicated regularly as this might mask a potential problem.
I truly recommend that you have another veterinarian give you a second opinion based on his/her examination of the horse and the radiographs.
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Question: We have a 10-year-old Half Arabian that has very successfully shown since he was 5-years-old. He is shod according to AHA's rules, which includes long toe with a pad. Over the last year we have discovered he is insulin resistant (IR) and have adjusted his diet accordingly. Over the past four months he has suffered from chronic laminitis and has been confirmed with Cushing's disease. We have started him on the pergolide medication, but ir is too early to see results. My question is, considering how he needs to be shod to shoe, is his shoe career over? We only want to do the best for him. Would you please advise if continuing to be shod will complicate/shorten his current health condition?
Answer: Click To View
Being shod with a long toe might place more strain on the hoof wall lamina and might be detrimental to the laminitis situation. Insulin resistance (IR) and Cushing's are two different metabolic diseases that can predispose him to laminitis and to its reccurence.
If the Cushing's and the insulin resistance are controlled through medication and diet, the laminitis might become stable enough for him to be sound, and at that time, based on how his feet feel and look like radiographically, you might try to get him back into show shoes. It is not the best shoeing for him by any mean, but if his laminitis is stabilized, there is a small chance to get him back going.
If you have the opportunity to retire him and avoid having to push him, you should consider it.
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Question: My 3-year-old gelding's right front shoulder or elbow pops when he walks. He is not lame on it, but I don't know if I should be concerned. I just noticed it a couple of months ago and it is still popping. He gets exercised about every other day due to the season. Would an x-ray need to be done or should I just ignore it for a while? Do they have new lameness tests?
Answer: Click To View
If your horse is not lame, this popping noise is not likely to be a problem. This said, you should still have a veterinarian evaluate the concern as many lamenesses are subtle enough not to be noticed by owners.
Radiographs of the shoulder and elbow could also be taken.
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Question: My 8-year-old Morgan gelding has not been wanting to move out at the trot, and has been choppy in his front since mid-Nov. More lameness was noted in his left hind leg and a bone scan was performed in January. The results were negative for Lymes and EPM as well as negative on the chemistries done. He has been on stall-rest with hand walking two to three times a day. He continues to be lame. Are there any furhter tests that are reccomended? What are the treatment options?
Answer: Click To View
Bone scan is a wonderful tool to use, generally. It involves injecting a radioactive compound in to the horse that is linked to a bisphosphonate (molecule that makes the radioactive material link to bone at sites of bone remodeling), and imaging the horse with a gamma camera. Areas of intense bone remodeling would show up as "hot spots". Unfortunately, this modality is not very sensitive for soft tissue injuries (tendons, ligaments, muscles).
Ideally, having your veterinarian do nerve blocks and joint blocks to localize the lameness would be ideal. Once the lameness area is detected, imaging that area (Xrays, ultrasound and, if needed, Magnetic Resonance Imaging -MRI-or Contrast enhanced Computed Tomography -CECT-) would be the next step.
Only after a diagnosis is made, would a treatment be recommended.
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Question: My new Quarter horse has been lame for probably close to two years now. He's had corrective shoeing and the massage therapist has been out to see him once and will be out again. We have x-rays of his feet from December of '08. He is VERY overweight right now, which started after he went lame. I take full ownership of him next week and I want to know what I should do. The shoes helped a some, but the massage seemed to help more; however he is still lame. I plan on getting weight off of him by changing his diet but I feel that I cannot excercise (lunge) him or anything since he is lame. Although, it does not look like he's in much pain, I don't know what to do.
Answer: Click To View
First thing I advice my clients when they start talking to me about problems about a horse they are looking into buying and that has this lameness problem is NOT to buy him.
Horses get enough problems as it is, you do not need to start with one.
If he is already yours, you will need to have your veterinarian out to localize the source of lameness based on a physical and lameness examination that will include nerve blocks (a common procedure performed when the veterinarian numbs various areas of the limb to see if it will improve the lameness).
Once the lameness has been localized, you could have it imaged: Xrays and ultrasound are what is in the first line of imaging, and if more is warranted, MRI or CT scans can be used.
With the diagnosis in hand, more pertinent advices can be made.
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