I have a 12 year old 18hh Hanoverian who has the early stages of navicular. He has some swelling in the navicular bursa, and is slightly lame at the trot tracking right (mainly a distinct head bob and short stride). He's been through a lot in the last few years, including a minor surgery for a bone spur behind his knee about a year ago. Because of the surgery, he was put on stall rest for months and because of that he developed DJD due to the constant pressure on the joints. We've blocked him up and down both front legs and he was 70% sound when we blocked the coffin joint, and about 90% when blocked at the navicular bursa. Everywhere else on the leg made no difference.
The problem is that I can't keep him sound. If we inject the bursa with hylaronic acid, he is sound for about a week then goes lame. He was on Isoxsuprine for about a year and showed no improvement. He has had an IRAP treatment for his deep digital flexor tendon about a year ago when he had his surgery. He was sound for about 2 or 3 weeks before returning to the same amount of lameness. His degree has remained constant throughout the last 3 years.
He has a quarter crack in the hoof he is mainly off on, about 70 to 80%, but we have had it checked out over and over again and it is not the problem. He had corrective shoeing on the fronts right now, with gel inserts and bump pads to keep his frog from prolapsing and evenly distribute his weight. He's a big guy, so it's been difficult trying to figure out what will work.
He is currently out in pasture right now, but I was hoping to try and rehab him back to light work, or even just as a trail horse. We were jumping 3'3 and 3'6 before all this, but I always made sure to take care of his legs and hooves after since he is so big and was still maturing.
I was wondering what my options are in terms of care for the navicular. I have tried just about everything except for the pelleted feed called Equibone. I was thinking of trying the experimental European drug called Tildren, but am not sure how it would work with him. I have xrays, mri scans, pictures, and a complete medical background on him if those help.
I would definitely consider the Tildren at this point. They have been using it for a long time in Europe if it makes you feel any better. There are pros and cons to every treatment, but me personally, I would probably go to the Tildren next. Have you tried Adequan injections or even Pentosan yet?
Tildren is pretty darn common here now. It can be done a few ways. I've done it in an IV drip, pushed very slowly (30 mins+). My vet gives banamine beforehand (Tildren comes with a risk of cramping/colic) and does it in the morning so you can watch the horse and give more banamine if necessary. It can also be done as one shot per day over 7 days to lower the GI risks, although my vet did not recommend it. Finally, some vets will do it as a limb perfusion if it is aimed at one area in one leg. It involved applying a tourniquet and placing the drug directly into the leg for a period of time.
The IV drip method tends to run between $800 and $1200. No idea on the others.
But yes, Tildren is for bony changes/remodelling. It isn't for soft tissue issues.
You have already done WAY oo much for your horse. What you should do is a neurectomy. I'm surprised your vet hasen't suggested it???? Please look into it. Every day, every year that you are letting your horse "go" per say, lame and trying this and that for his comfort and soundability is one less day you have to correct the problem and make your horse rideable, comfortable again.
My horse is a belgian X. Diagnosed with navicular 2009. Instead of injecting everything with no results or temporary results, I did the initial xrays and I was told he has navicular and right then I said let"s do the surgery. I did and he has been sound to this day with no bad step at all. If you want to PM me with his/my story please do so. It"s not the end for your horse.... you just ventured too many avenues for no reason.
You mentioned you had MRI results; any soft tissue damage? The MRI on my horse showed some soft tissue damage along with the degeneration of the navicular bone. Unfortunately, both specialists (from different clinics) believed there was an adhesion between the DDFT and the impar ligament. So, when he is not ridden he looks quite good but any riding beyond short walks a few times per week will result in a pull on the adhesion and lameness.
I did two rounds of Tildren with no noticeable improvement and have not considered a neurectomy as riding him would simply result in further soft tissue damage. He is pasture sound.
A neurectomy makes the horse "sound" only insofar as it no longer appears lame. It does nothing to stop the progress of the degenerative process. Riding a horse that has had a neurectomy probably accelerates the progress, in fact, because you forget to be conscious of the "lameness". Eventually, something traumatic and probably final will result, rather than you knowing when it's time to retire the horse to a pasture, or do the kind thing. Just be aware of that, if you choose that path. There are also things you need to be even more careful to watch for because the horse can't tell you when they happen (bruises, abscesses). Not a decision to be made lightly.
Go look at my navicular thread. I recently had my horse at a hoof care workshop where his confirmed navicular diagnosis (radiographic evidence of navicular bone damage) was shared with 25+ professionals involved with equine soundness; not one of them at any time even said the word neurectomy.
"One person's cowboy is another person's blooming idiot" -- katarine
Ozone - neurectomies are not necessarily a permanent fix. Many, many times scar tissue regrows in that area - painful and disabling. The vets I spoke with re neurectomy regard it as a last stage effort prior to euthasia. What area of the country are you in and were the recommendations for neurectomy made by an orthopedic specialist?
We have done the regional perfusions of Tildren to the legs with good success. It is much cheaper than the whole body IV injections. We have also done navicular bursa injections with steroid and hyaluronic acid, and IRAP injections to the coffin joint. We were able to keep our guy sound through age 18 and intermittently sound through age 21. Now, at 25, he is very lame. He has a lot of other health problems now, so I am not sure a neurectomy would help him.
Because every navicular horse is VASTLY different, with different pathology going on, what works will vary from horse to horse (as I am sure you already know). My newly diagnosed navicular horse had avulsion fractures of both navicular bones (as well as significant bone degeneration), and impar ligament desmitis. His DDFT and that side of the nav bone were fine, as well as his navicular bursa. Can you share a little more about what was specifically found in the MRI? That might help narrow things a bit.
Just throwing this out there - my horse can't stand the sole pressure from those frog support pads like your horse has. Heck, he can't stand any sole pressure right now on his RF. Have you experimented with shoeing? Has your farrier taken hoof testers recently to your horse to see if perhaps the frog support pads might be hurting? This is just a shot in the dark, but just a thought. Also, are you positive your farrier is the best lameness-specialized farrier you can find? I just made a farrier switch and have high hopes with the new shoeing job. She took off his eggbars with 5 degree wedges and put him in PLR shoes w/ rails for the wedging, a hard plate to stop all sole stimulation until he is sounder, and used very soft impression material underneath the plates. She said this type of shoeing w/ PLRs is the "latest and greatest" for navicular horses and better than eggbars (I know every farrier has different opinions though... mine has been in eggbars since October so I understand their value). His breakover point is much further back now which is what my vet has been asking for for months, and he has sooo much more caudal support because she wasn't afraid to set his plate and shoes further back. If you happen to be in New England and are interested, I can put you in contact with my new farrier.
My horse had 3 rounds of shockwave (for the fractures and impar ligaments), 1 IV round of Tildren so far, 2 coffin joint injections (first with just HA and second with steroid/HA). I found the steroid/HA injection to definitely help, though he is not 100% sound and most days he has a slight head bob with some sound days thrown in. More sound days post coffin joint injection #2. Can your vet inject the navicular bursa with a steroid as well? I'm not sure if that's "done" with bursas though, I really know nothing about them. What about coffin joint injections? A round of PentAussie or Pentosan? A regular low dose of previcox?
A neurectomy is not something to take lightly. I've thought long and hard about it but I personally have decided against it. I read more and more about them only lasting for a couple of years, risk for painful neuroma formation, and then I worry about things like what if he stepped on a nail and no one catches it soon enough because he can't feel it and is still running around. I certainly would not begrudge anyone making that decision for their horse and sounds like it has successfully helped many horses, but at this time it's not something I would personally want to do and take those risks. I think if my horse got to the point where he couldn't comfortably be pasture sound with NSAIDS, I would euth.
Keep us updated on what you try and how things go. I am still in the middle of trying to get my horse sound enough for a light to moderate amount of flatwork. He's only 8.
"And I saw heaven opened, and behold a white horse..." ~Revelation 19:11