For those using PRP--finally a little evidence.

[deltawave]

Not promising, but hey--after a couple of years of marketing the stuff, at least now there is beginning to be a little effort at research.

http://jama.ama-assn.org/cgi/content/short/303/2/144?rss=1

And if that sounds bass-ackwards to you, well, it does to me too. :rolleyes:

[asterix]

Actually, a review article (for lay people, anyway) in today's New York Times...not very encouraging....

http://www.nytimes.com/2010/01/13/health/13tendon.html?scp=1&sq=prp&st=cse

I think you need to be registered to view, but it's free....

[deltawave]

The NYT article references the JAMA article, which was released today. :) Nice to see it in layman's terms, though, and very timely. :yes:

[Gayla]

Is this IRAP?

[deltawave]

Not the same thing, but a similar "cart before the horse" marketing thing going on. The two things are not gigantically different in theory, and both are widely used without much in the way of actual data showing effectiveness. :sigh:

[FineAlready]

Thanks for posting this! If anyone has similar studies on stem cell, I'd be interested.

And, FWIW, I used shockwave on a ligament injury and personally felt that it resulted in amazing improvement. Or, put another way, there was amazing improvement, and I think it was due to the shockwave. Always so hard to tell with these things whether it is the treatment, the rest, or a combination of both that is helping the horse...

[grayarabpony]

Thanks for posting this! If anyone has similar studies on stem cell, I'd be interested.

And, FWIW, I used shockwave on a ligament injury and personally felt that it resulted in amazing improvement. Or, put another way, there was amazing improvement, and I think it was due to the shockwave. Always so hard to tell with these things whether it is the treatment, the rest, or a combination of both that is helping the horse...

Yes, I felt shockwave helped my horse too, although it didn't resolve the problem. The problem is you can never really know for certain which thing or combination of things caused the end result..

[wendy]

I used shockwave on a ligament injury and personally felt that it resulted in amazing improvement. Or, put another way, there was amazing improvement, and I think it was due to the shockwave. Always so hard to tell with these things whether it is the treatment, the rest, or a combination of both that is helping the horse...
the actual controlled studies on shockwaves, which I studied carefully a couple years ago (which naturally were not done in horses) suggest it doesn't do anything at all for ligaments/tendon injuries. It may be helpful to relieve pain caused by calcium deposits.

[deltawave]

The problem is you can never really know for certain which thing or combination of things caused the end result..

Especially when the danged patient can't TALK to you! I don't know how vets do it . . .

But this is exactly why we need good, controlled studies. LOTS OF THINGS get better in spite of or because of the things we do. But before we all cough up hundreds and thousands of dollars, it would be SO nice to know if the treatment being proposed actually helped 10% of horses, 50%, or 90%. We get desperate to help them and sometimes I feel like just writing the check makes us feel better. :sigh:

[grayarabpony]

Especially when the danged patient can't TALK to you! I don't know how vets do it . . .

But this is exactly why we need good, controlled studies. LOTS OF THINGS get better in spite of or because of the things we do. But before we all cough up hundreds and thousands of dollars, it would be SO nice to know if the treatment being proposed actually helped 10% of horses, 50%, or 90%. We get desperate to help them and sometimes I feel like just writing the check makes us feel better. :sigh:

Studies help us make decisions on what is the best bet as a therapy. However, there's always that annoying nagging fact that an individual isn't a study. What works in one situation and for one individual may not work for another, etc, especially with drugs... let's face it, if especially if the horse is young and otherwise healthy, we're probably going to end up writing that check. :sadsmile: It's our destiny as horse owners to shell out money.

I think that shockwave therapy helped my horse, for example, but exactly how I do not know. He only had an ultrasound done and not a MRI. Perhaps there were small calcium deposits interferring with the suspensory that were broken up by the shockwave.

[FineAlready]

the actual controlled studies on shockwaves, which I studied carefully a couple years ago (which naturally were not done in horses) suggest it doesn't do anything at all for ligaments/tendon injuries. It may be helpful to relieve pain caused by calcium deposits.

Hmm...also very interesting. I love learning about these things, even if I don't like HAVING to learn about them, lol. It's true that my horse's ligament healing might have been entirely due to rest. The timing of the healing was such that the horse's ultrasound was not improving for several months, we did three shockwave treatments and at his appointment 2 months later the ligament appeared close to 100% healed on ultrasound and the horse was sound. Of course, perhaps those 2 months would have resulted in the same amount of healing with or without shockwave.

Made me feel better to do it for sure...especially since it was covered by insurance. Actually, my claims adjuster told me that he believes that shockwave works based on the results he has seen in horses on whom major medical claims are made. Interesting stuff.

[annikak]

. .

We get desperate to help them and sometimes I feel like just writing the check makes us feel better. :sigh:


Well, ain't that the truth??
No truer words have been spoken....:cool:

[purplnurpl]

oui.
Here is what I know.

My horse was diagnosed with his ligament tears in April.

The vets told me not to wait around and to get another horse because it's going to be 6-8 months maybe even a year.

I did PRP (which according to research does nothing)
Shockwave (which according to research does nothing)
and cold laser therapy (which according to research does nothing)

3 months later it was 80% healed and the horse was sound. 6 months later it was resolved.

Did I mention it took us 9 months to diagnose this issue? We were treating a badly bruised ankle/foot for 9 months. So for 9 months he was grade 1 lameness on the leg. 3 months after all of those interventions he was fine.

so something worked here.

[deltawave]

Please note I'm not saying "don't use it". But if good research continues and there's enough of it, someday we'll be able to decide when, which, and what therapy might help without guessing, without the uncertainty, without the failures that rarely get talked about.

[Lori B]

Thanks, DW, for drawing my attention to this article.

I noticed (in the NYT article, I didn't have the bandwidth to read a medical journal article this second) that the studies were done on TENDONS not ligaments; don't know how much that matters, but that's one thing.

In my own dataset of n=1 regarding the treatments for suspensory ligament injuries:

First we did shockwave 3x, shortly after diagnosis, and the ultrasounds seemed to improve markedly; started back to work even lightly a couple of months later, and we were back to lame and worse ultrasounds.

Second we did PRP, and her ultrasounds were so much better after the 2nd one, we didn't do the third, and we started back to work (and I am talking about very judicious walking under saddle and very slow re-intro of trotting) and bang, she is soon lame again, and ultrasounds are back to crummy.

Third we went to a specialist (should have done that sooner), and she said, no big interventions necessary, she is healing, but slowly, she now needs TIME.

6 months after that wise judgment, we are poised to start work in a few weeks. Ultrasounds are much much better, and the rare occasions when I trot her in hand she seems very very sound.

If I had it to do again (and please, I don't wanna do this again, ever), I would be strongly inclined to just go straight to paddock rest with maybe some ESWT, and resign myself to a year off, not even think of getting on her for that long. 6 months in a paddock, 6 months turned out for real.

All of the therapies we did seemed to make things better on the surface but nothing gave us a truly resilient and healed ligament but TIME.