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  1. #1
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    Default hock injections, steroids and fusing

    I have taken both my older horses to have their hocks injected. The vet just used a steroid (sorry I don't know remember what it was) instead of HA and a steroid or just HA.
    His theory is that in an older horse you want the hocks to fuse, so you use the steroid to hasten that process.
    I have to say I am a bit uncomfortable with that theory. If your horse is 18 and his hocks haven't fused why would you want them to?

    One of my horses is an ex grand prix horse who I bought from my trainer. I know he got his hocks done regularly, but with HA. So......

    What does your vet use? And why
    "Half the failures in life result from pulling in one's horse when it is leaping."

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  2. #2
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    Hocks that are in the process of fusing HURT. Hocks that have completed the fusing process do not hurt.

    If the radiographs show that the hocks in the the fusing process, steroid can hasten that process and get the horse pain-free sooner. Steroids are also powerful anti-inflammatory, so they will provide pain relief all on their own.

    If the hocks are fusing, it's my understanding that HA with lengthen the time it takes. HA will lube everything up, and has it's own anti-inflammatory properties, but you've still got fusing hocks.

    The vet I use uses depo-medrol on fusing hocks. It's a long acting steroid (longer than triamcinolone) that will hasten fusing.



  3. #3
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    To my knowledge, unless you are injecting with something caustic to actively hasten the fusing, you aren't doing any good by just injecting a steroid. Injecting only a steriod, over repeated injections, can damage the joint.

    Unless you are actively working to fuse the joint (ie chemical fusing), there is no guarantee that not using HA or Legend or whatever is going to speed the process up. Hock joints can take years and years and years to fuse, and most don't in the horse's lifetime. My TB gelding developed spurs at 8, and the vets at NCSU said "yes, this is the start of what could be fusion", but nope, they weren't fused at all by the time I lost him at 20.
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    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET



  4. #4
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    I would really hesitate to call steroids "caustic." When injected into the joint, they change the cartilage matrix (great rundown here). It's not like we're injecting lye into the joint capsule.

    When injecting the lower hock joints in a horse that's fusing, you WANT to damage the joint. You want the horse to create enough bone so that a joint no longer exists there. Steroids encourage this process while treating the pain and inflammation that the process causes.
    Last edited by Simkie; Nov. 21, 2008 at 10:10 AM. Reason: spelling



  5. #5
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    I wasn't calling steroids caustic My use of caustic was in relation to whatever chemical it is that is injected to actively, hurredly invite fusing. I don't know the name of the chemical. The process is chemical arthrodesis. Ok, just looked up the chemical - monoiodoacetate aka MIA. The article I found said that ethyl alchohol shows better fusion with less lameness during the process. http://www.equisearch.com/horses_car...fusing_122006/


    I was saying though that just injecting steroids can, over the long-term (ie repeated injections) cause deterioration to the joint. That is why things moved to also using HA or Legend or whatever else is used in conjunction with the steriods, so that actual lubrication could occur as well as a reduction in inflammation.
    ______________________________
    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET



  6. #6
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    Quote Originally Posted by JB View Post
    I was saying though that just injecting steroids can, over the long-term (ie repeated injections) cause deterioration to the joint. That is why things moved to also using HA or Legend or whatever else is used in conjunction with the steriods, so that actual lubrication could occur as well as a reduction in inflammation.
    But that's the point! They precisely WHY some vets use only steroid in the lower hock joints. They WANT the joint damaged. The joint IS already damaged and fusing. They want the joint to be damaged to the point where it's no longer a joint. Once that happens, fusing is complete, the horse is pain free and there is no longer any maintenance, because there's no longer a joint to cause pain.



  7. #7
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    But I thought that the steroid caused the type of damage that was not conducive to fusing, only to deterioration (which does not automatically lead to fusing) which is why it's use alone was left behind in favor of adding a "lubricant" as well.

    But, IF it is true that a steroid alone helps speed up the process, why wouldn't one go straight to the chemical fusing process, using the 2 chemicals I mentioned above, that are KNOWN to cause a relatively quick fusing? Just a steroid is no guarantee fusion, and since the fusion process IS painful, encouraging it in a s-l-o-w manner just seems cruel
    ______________________________
    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET



  8. #8
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    My vets have always said that steroid hastens the fusing process. I have never once heard that steroids cause damage that is not conductive to fusion. If you go read what is linked in my previous post, the damage describe looks to be the sort of damage that would hasten joint fusion.

    I suspect that the chemical fusion meds do create fusion, but I'd bet money it's pretty painful. I bet the joint is very sore and very hot for a period of time. With steroids, you're creating damage that leads to fusion, but you're also treating the horse's pain and inflammation. I've known several horses that only needed their hocks done once or twice and they were done fusing. Who knows how long it would have taken without the steroid.

    I would absolutely disagree with you that using steroid is cruel. You're treating the horse's pain and you're helping it to be pain free sooner than it would have been on it's own. HA, on the other hand, slows the fusion process.

    I guess injecting HA *does* keep the client coming back for more, though I wonder if there are some vets out there who use HA because it guarantees return visits...



  9. #9
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    I unfortunately don't remember the reasoning on this, but my vet also uses steroids for hock injections on older horses. It's been several years since we discussed it; we had been debating the benefits of injecting a very old retiree, but did not because he is also an EPM recoveree, and we didn't want to risk the use of cortisone, and she didn't feel that he would get much benefit from HA (I'm thinking he was around 28 at the time, so probably a different situation than the OP's horse).



  10. #10
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    What I mean by "cruel" is that since there is no guarantee of fusion with a steriod, and if all you're doing is reducing inflammation but not providing any additional lubrication, and you're using a steroid by itself in order TO speed up fusion, why not go straight to something that is *known* to cause fusion, and apparently pretty quickly? The ethyl alcohol treatment, according to the article, showed "minimal or no lameness". It doesn't say what degree of lameness the MIA caused.

    This article may say what I'm trying to in a much better way - see the section on IA injections
    http://www.thehorse.com/ViewArticle.aspx?ID=3394

    However, there is a point at which the frequency of steroid use in a joint becomes unreasonable and destructive.
    I take "destructive" to be just that - destructive, and not destruction with a goal of pain-relief fusion. That's just a snippet though, it alone is not the whole picture
    ______________________________
    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET



  11. #11
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    Quote Originally Posted by JB View Post
    What I mean by "cruel" is that since there is no guarantee of fusion with a steriod, and if all you're doing is reducing inflammation but not providing any additional lubrication, and you're using a steroid by itself in order TO speed up fusion, why not go straight to something that is *known* to cause fusion, and apparently pretty quickly? The ethyl alcohol treatment, according to the article, showed "minimal or no lameness". It doesn't say what degree of lameness the MIA caused.
    Huh. That's interesting! Here is an article that actually does mention using ethyl alcohol to get fusion. It sounds like it is still not a fast process, and you do have to do additional imaging of the joint.

    I think something else to take into consideration is how little the lower joints actually move. How much lube do they need?



  12. #12
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    Ok, back to my question.

    We just did flexions on both horses, 1/5 on both hocks on one and 1/5 and a 2/5 on the other.
    No xrays were taken, so how do we know that their hocks are in the state of fusion?
    Is it just assumed because they are both over 15 that their hocks would be fusing?
    And since they have now had steriods injected does this mean that I have ruined hocks that were not all that bad?

    Also if you were injecting HA, or HA plus a steriod why go that route vs. the steroid only route?
    "Half the failures in life result from pulling in one's horse when it is leaping."

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