Cost of neck injections to C5/6/7 area? ESWT for ringbone? Pentosan options?
What was your expense? I am sitting down.....
Diagnosed this past week. I thought I would try injections and if improvement take it one day at a time, rethink his current training regimen to keep him sound for a while. Ringbone changes just in the last 4 months, but the neck I feel has been the bigger issue riding him this past year as it has been ongoing. I am familiar with shoeing expense for ringbone, but I read that ESWT is also an option if caught early.
I haven't ruled out use of pentosan or tildren. He is already on dose of Nat. E..(5000 IU's I think), MSM and Mg 56% Given that pentosan is increasingly harder to come by when they run out, how have you dealt with that if you have your horse on Pentosan?
Cannot help with the other ?s but a friend's horse has fairly gnarly ringbone and shockwave has been absolutely critical to keeping him sound. I'd definitely give it a try to see whether it helps - it is not invasive so...
I had cervical injections done 2 years ago. Vet did 3 injections on each side of the neck, so a total of 6 shots. I believe the cost was about $850, though I'm stretching my memory. The vet told me that these injections are not something that you generally do on a maintenance basis, and that if he did them a second time they would not last as long. I got lucky on my then 22 yr old, as he went from being neurological to rideable at low level dressage. Fast forward almost two years, and I recently stopped riding him - there as been some impact on his stifle, which has gotten loose/slippy in spite of his decent fitness. When he is free lunged in round pen, rarely visible so I'm believing that the pressure of rider and saddle is the problem. He is otherwise comfortable and I don't believe at his age that I will do a second set...
We don't get less brave; we get a bigger sense of self-preservation........
I have numbers for IRAP in the neck at home. Not inexpensive as it's ultrasound guided and it involves several injections. I did it twice a year apart. First year was pretty good tho I never went back to jumping. Second year not as good but not bad. Nonetheless I opted to retire the horse last week as opposed to doing it a third time.
Oh, Peggy. I'm sorry to hear you've gotten to the point of retirement
OP, it was a few hundred bucks to inject the facets at C6/C7. $300-400 ish, IIRC. I would not expect the pricing to go up HUGELY with injecting more places, as long as you are using steroid (it's cheap!) IRAP would be considerably more. I got about 6 awesome months the first time, a few weeks the second and retired the horse at that point.
Yes, Simke, but the horse seems pretty happy. (this link should be public--the photos from the retirement place are near the end). I wrote a bit about it in the thread on whether or not to retire your horse (may have been in dressage) and one I started on whether to go with the horse to the retirement place. The short version is that I looked over the last year and the fact that I spent a lot of time bringing him back into work from various NQR leg things, the ulcers, and the intestinal issues. I'm not sure that going out and getting ridden was all that fun for him some of the time. I felt that the assorted GI issues were under control. I didn't want to use him completely up as that didn't seem fair, and a bit early was better than too late.
My bill for the injections are not of much use for anyone not doing IRAP. The vet bills for the IRAP as a unit--so all of the charges associated with putting it back in the horse are included in the original draw. Since it took two units worth of IRAP, at $900 each (is the OP still sitting down?), the total was $1800. There is probably still some of his IRAP sitting in the vet's fridge as I don't think what we did took two full units. As to why we did IRAP? The first time it was on the insurance company's dime and the vets felt we'd get a better result. The second time it was on my dime, but it had worked well before and I had the dime. IIRC, a friend paid just under $1K for several places in the neck and maybe something else but her vet is pricier than mine.
My vet bills for shockwave by the pulse at 20 cents per pulse. This seems like quite a deal until you realize that the check ligament (yes, different horse) took 1000 pulses for each of three treatments. So, $600 total.
You might want to try a course of ESWT for the neck arthritis and the ringbone, especially if your vet is like mine and doesn't charge extra to do multiple areas. My older guy with articular ringbone responded extremely well when we combined pentosan, Cosequin ASU for three months, plus the ESWT. I like to think the three complemented each other and provided for some healing. Right now we are at least 13 months since our last single booster session of ESWT which was done about a year after the first series. He is still sound on MSM as his only "soundness" supplement. My vet also did his neck and SI at the time since he exhibited pain and stiffness in those areas as well and assumed arthritic changes, and ever since those areas have also been much improved. Cost was $350ish including sedation, initial series is usually three times of ESWT. So $1050. Pentosan was $150ish for a bottle and did a series of four shots one week apart beginning the series prior to the first shockwave session, then once a month till the bottle was finished. Some horses love the ESWT and don't need sedation so that can cut costs.
Of all the things listed the modality I would have the easiest time swallowing as safe, effective, and likely to help would be the cheapest: Pentosan. It's plenty easy to get at the moment. I've yet to see anything compelling about IRAP and all of the other "alphabet soup" blood-based injectibles beyond anecdotes and limited research in vitro. Same with shock wave. Steroid injections in the neck . . . maybe. My horse had an equine version of a "stinger" after I first got him and responded well to just oral corticosteroids and a couple of months off with lots of longeing in a low frame.
Yes, still sitting down. Right now, that cost is scary as I haven't even seen the bill for the rads I had done. A couple of years ago, I spent a boatload of $$ trying to figure out why he went lame. A year off, special shoes, we were sound for most of the last year. He isn't too bad now (maybe a 1 on the scale). He is very comfy and happy walking, trotting along with his head/neck stretched outward. I just do not want to keep pouring $$ into him and thinking this is the fix that will get us back on track. I need to look at this as maintaining his comfort for now as this cycle will probably be recurring (has been his MO for at least 3 years).
I believe my plan will be to continue the shoeing with fancy shoes, no neck injections as of yet and use him as my w/t horse to keep me fit. I have an opportunity to ride a schoolmaster a couple times a week, so coupled with some rides to keep Studly busy with some sort of job, this might be my answer for now (for me) . If it comes to the point that he is uncomfortable just walking or trotting with out a lot of contact, then I will reconsider the neck. He had been on pentosan, but we are about 3 or 4 weeks behind now because of the shortage/backorder, so I will continue with that when it comes in. For those that use pentosan, how do you deal with the shortage issues? Do you order after you do your first 4 doses so you do not have that lag time in between?
The horse I retired was somewhere between zero and a bit more that zero on the neuro scale. He passed all the tests except that he refused to wear a blindfold so we never knew how he'd walk with one. Both vets emphatically said that my horse was not neuro.
In addition to the neck (and other issues) my horse also had an ongoing collateral ligament issue in the feet that the vets felt was exacerbated by the neck issues. One vet described it as a transient compression of the spine during which a packet of information doesn't make it down the spine, the horse has a moment where he loses a bit of proprioception and he puts a foot down harder. These accumulated harder footfalls exacerbate issues that are already there or even create new ones. Just thinking of the OP's horse's ringbone and wondering if something similar could be going on.
What I would feel in general if his feet and/or neck were bothering him was a stabby way of going with his front end. It was worse to the right; on bad days to the right it would feel like he was pulling himself forward by popping up with his neck. So, for the last month before I retired him I simply didn't trot circles to the right. The other thing I'd feel with this horse from time to time is that it would seem like a front foot moved forward and moved wrong in the air. Pretty danged subtle. Occasionally this would be followed by a stumble, but I learned to sit quietly and make sure my shoulders were back when I felt that.
ETA: As for your bit about the transient information...that has been the hunch from my body worker and myself right now. Although the vets feel the foot came first, which it did, as he was born with a club foot, that could have been fixed with surgery (I think I am remembering that correctly). So, he had a lot of strikes conformationally against him from the get go. Interesting about the neuro, over the last couple of years, I have noted on some occasions after saddling or when starting off, he feels "drunk" for lack of better words. Definitely something to keep a check on now. Thanks for the stories and experiences, advice.
OP - Prior to my doing the cervical injections, my guy was clearly showing neuro symptoms. As said, the shots helped A LOT and even now two years later, no tripping, weaving, etc. When I put him back to work after the shots, he was most comfortable with long, low work, so I would say that you are on track w/ riding him that way. I think others have posted same.
In the last few months mine has been less interested or comfortable in canter work; that was my first indication that perhaps the benefits are fading. The slippy stifle issue mostly makes me feel bad, so this I decided at 23++ that he doesn't need a job.
You seem to be on a reasonable track w/ the plan you have, but I'd second the close observation of neuro symptoms - if they occur, you may have some different decisions to make. Good luck.
We don't get less brave; we get a bigger sense of self-preservation........
Do be careful with any neuro horse, especially one that's untreated. I'd not ride anything that felt "drunk." Tripping and falling can be disastrous.
My mare is a bit like Peggy's horse--she is very slightly neuro and would be graded very low, if at all, by most vets. But she doesn't swing evenly from behind and she's got some funny proprioreception issues in her hind end. For this horse, it's just not fair to make her work, although she's really just fine and happy to hang out in the field. She's safe to work around although we do sedate her a bit to trim her, as she seems to have some anxiety about holding up her hind legs (I really suspect she just doesn't really understand where they are in space.)
If you continue to work your neuro horse, just be very careful and mindful. Horses with neuro deficits can really be dangerous. And if he really feel "drunk," I'd seriously consider NOT riding him through that, if you ride him at all.
I use pentosan on an older horse. That and previcoxx keeps him in work and happy. The shortage hasn't been an issue for me. My vet doesn't like doing the script for compounded. Its coming from Australia.
I have done IRAP on this horse for his stifles. It worked well the first round. The second was a waste of my money. I only got about 2 months of good work out of it. I get more payoff from the pentosan and previcoxx.
One of the horses in the barn has neck arthritis. He's never had injections in his neck. Just hocks. He gets pentosan. He's a working fool and is going better than ever.
When you have a horse with arthritic changes you must be zealous about shoeing, work surface, and correctness of work. A younger horse can cope better with these problems, but once changes start, its a race against time. My older guy is continuing to progress and build top line and muscle. But he requires very careful correct work. As well a 20 year old horse should get.
I would do the loading dose of pentosan. Its pretty cheap for the pay back.