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Pentosan and fusing hocks?

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  • Pentosan and fusing hocks?

    I have an aged gelding who is going through the hock fusing process. We did x-rays and the vet thought there was enough joint space to inject, so we tried but she was only able to push a little (ha/steriod combo) into the joint.

    I've taken the approach of waiting and just managing pain (previcox) as best I can. This horse is the best thing I have to ride at the moment, and though his attitude is just the same (seems happy to work and have a job despite the discomfort) I just am having a hard time riding him while he's so lame, despite the fact that vet and farrier both agree that is what I need to do.

    Vet initially suggested Adequan (or was it Legends?) but after doing some research, I don't want to use anything that is going to "preserve" the cartilage. I don't want to inhibit or delay the fusion since all indications are he will be more comfortable after that happens.

    Several (both IRL and on this board) have suggested pentosan. I don't know how it works though. Does it also preserve the cartilage or delay its degradation?

    I'm trying hard to just wait this out but patience is not my strong suit. I've been doing topical DMSO and cortisone just to give me something to "do" while I'm waiting, and because I feel the need to do something to make him more comfortable. I also feel like I must pay some sort of pennance for riding him while he's lame. Don't get me wrong, we just walk and shuffle around the property, but I still feel bad, and want to do more to help him.

    I'm trying to convince myself to give it the rest of the winter and then see where we are. Otherwise I'll be looking in the alcohol arthrodesis in the spring. I've heard stories of horses who never fuse, and I don't want that to be the case. He compensates for the discomfort and I'm starting to see mild uneveness elsewhere for that compensation. Just keep wondering if there is something else I could do to help him.

  • #2
    Sure, go ahead and use Pentosan. It is basically like Adequan in it action in a joint. It integrates into the cartilage and aids in aggrecan preservation.

    There is no difference between "preserve" and "delay it degradation." I am not sure what you want to do?

    Legend is a mild anti-inflammatory. So I would go with your vet's recommendation.

    Comment

    • Original Poster

      #3
      Well, the goal is for the hocks to fuse. This is the one instance where you want the cartilage to degrade, so the bones of the lower hock can fuse together. When that immobility occurs, the horse will no longer be in pain. Or so I'm told. It's just the fusing process that is painful.

      The other option is alcohol arthrodesis, whereby an injection of alcohol is used to hasten the degradation of the cartilage.

      Local vet suggested the Legends and Adequan. Others have mentioned pentosan. Lameness vet and my research tell me that I do not want to do anything to preserve the cartilage...that will only delay the fusion. Common wisdom is to ride and bute the horse to keep him moving to help the fusing process along. I'm just struggling with riding such an obviously lame horse.

      I'm somewhat heartened by the fact that the farrier was out today and felt that I just needed to stay the current course...horse is happy to work still and tore off at a canter after I put him back out after having feet done. He is still jogging lame on the concrete aisle but truly doesn't seem depressed or otherwise resenting the small bit of work I'm doing with him. Farrier told me if I feel the need to do something, just rub some liniment on it, since liniment was invented for the sole purpose of giving owners something to do, according to him.

      Comment


      • #4
        My horses hocks are fusing and Previcox has been helping him a ton. I also do IRAP injections to help him continue to use himself so he can continue to fuse. I think once the cartilage is worn down to the point where they are basically bone on bone that it cannot be stopped but just made a bit more comfortable to enable them to continue to function during this process.

        Comment


        • #5
          What is the status of his upper hock joints? Hopefully you Xrayed them too.

          My horse's lower ones are fusing - almost done. But his pain and lameness was coming from an upper joint. We injected it and are now doing IRAP. Also, Adequan helped him tremendously during the fusing process. It did not deter anything. As a matter of fact, before Adequan, the vet was very leary that they would ever fuse. Almost 8 months later, we re-xrayed and they are basically fused. He gets Adequan every other week, and 1/4 previcox daily.

          The IRAP will treat that upper hock joint.

          Comment

          • Original Poster

            #6
            All joints of the hock were on the same film, various angles taken, both legs. I don't think I've ever heard of just x-raying lower hock?

            Upper joint is not without arthritic changes, but not nearly as severe as the lower. It's very apparent that is where the issue lies. Unfortunately there is also a bony spur there, on the outer part of the joint, non-articulating or non-articular I believe is what the vet called it, but basically she didn't feel it was an issue. It looked like there was enough joint space to inject but when we tried she couldn't push hardly any fluid into the joint, so it was worse than the x-rays appeared.

            The farrier felt he actually looked better today, though definitely still markedly lame. We changed his turnout partner because I think my TB was running him, and he does seem less stiff.

            I don't have huge goals for him. He's just one of those gems that is the same for every rider, and quiet enough to put my timid 12 yo niece on (he was obtained in order to restore her confidence). He's my trail horse too. Just one of those all-around good guys that everybody wants and needs, so I really just want to keep him going. Which is why everyone tells me to keep riding him to keep him fit, but it nags at me to feel him gimping along beneath me. The vet and farrier both say he'll tell me when he needs to fully retire.

            I think I'll skip the pentosan too. I couldn't find anything about its method of action but it sounds like it's a cartilage "helper" and that's not what he needs right now.

            I have some leftover flector patches (diclofenac, aka surpass for horses) that I haven't used and I'm wondering if I could find a way to use them on him, though I'm not sure how well they'll stick or transport the meds transdermally since he's so hairy. Maybe if I shave his hocks and duct tape the patches on?

            Comment


            • #7
              Originally posted by Warmbloodmom View Post
              My horses hocks are fusing and Previcox has been helping him a ton. I also do IRAP injections to help him continue to use himself so he can continue to fuse. I think once the cartilage is worn down to the point where they are basically bone on bone that it cannot be stopped but just made a bit more comfortable to enable them to continue to function during this process.
              This makes no sense. IRAP will slow the fusion process by inhibiting the inflammatory process needed to grow new bone.

              IRAP is a biologic anti-inflammatory that works on specific pathways. How does your vet explain this application?

              The mode of action for pentostatin has not been directly determined in studies. It is believed to integrate into the cartilage surface like Adequan.

              X-rays are not the best method to look at joints as they can not image cartilage. All you can do is to guess the space looks adequate. Only by going in the joint or an MRI can you get an Idea of the cartilage condition.

              Comment

              • Original Poster

                #8
                Originally posted by RAyers View Post
                This makes no sense. IRAP will slow the fusion process by inhibiting the inflammatory process needed to grow new bone.
                This is my problem. Most interventions (legend, adequan, pentosan, etc.) are aimed at improving/maintaining/preserving cartilage, but I'm at the far end of the spectrum and need to dispense with the remaining cartilage.

                What do you know of alcohol arthrodesis or fusion? That's about the only option left, to chemically help the fusion along. My internet research has yielded mixed reviews, although that is only anecdotes from various boards FWIW. Seems like I keep coming back to tincture of time but as I mentioned before waiting patiently isn't really my thing.

                Comment


                • #9
                  Confusion here then, when you inject the lower joints with a typical injection of steroids/HA does that also suppress inflammation? My horse has IRAP due to being IR/Cushings and cannot have steroids. My vet feels that by suppressing the inflammation it will allow him to work and continue to fuse just as regular injections will without the side effects of steroids to his system (he previously foundered). I am under the impression that all IRAP does is suppress inflammation but does not regenerate cartilage. In other words it does not stop the disease.

                  Comment


                  • #10
                    Maybe try the previcoxx to keep him comfortable while he fuses?
                    Boyle Heights Kid 1998 16.1h OTTB Dark Bay Gelding
                    Tinner's Way x Sculpture by Hail to Reason
                    "Once you go off track, you never go back!"

                    Comment

                    • Original Poster

                      #11
                      He is on previcox.

                      I haven't really looked into IRAP...I've heard of it but don't know what it is (don't even know what it stands for...will have to do some googling).

                      Unfortunately I think this is one of those situations where there is very little to do but wait and hope the darned things fuse.

                      Unfortunately I have a geriatric herd. I don't like the idea of the end of this guy's riding career possibly looming on the horizon. He's my best horse and I really just want him to be trail sound until he dies. How sound does a horse have to be for walk-only trail rides? I mean as long as he's willing, still trots and canters at liberty in the pasture, and doesn't seem sour about being ridden it's OK, right?

                      Comment


                      • #12
                        Have you tried shockwave? I've had some success with shockwave, pentosan, adequate and legend on a high level jumper.

                        Comment


                        • #13
                          Originally posted by meaty ogre View Post
                          This is my problem. Most interventions (legend, adequan, pentosan, etc.) are aimed at improving/maintaining/preserving cartilage, but I'm at the far end of the spectrum and need to dispense with the remaining cartilage.

                          What do you know of alcohol arthrodesis or fusion? That's about the only option left, to chemically help the fusion along. My internet research has yielded mixed reviews, although that is only anecdotes from various boards FWIW. Seems like I keep coming back to tincture of time but as I that mentioned before waiting patiently isn't really my thing.

                          I think the benefit of preserving the joints is so minimal that I would not worry about slowing down the degeneration. I would also be surprised if you would get much benefit from legend or adeqaun or pentosan. Personally I would try them though. If it were me I would just focus on what ever kept the horsey as comfortable in possible in work. If he is not comfortable with management then I would probably not ride and just as much turnout as possible with previcoxx.

                          Comment


                          • #14
                            Originally posted by meaty ogre View Post
                            What do you know of alcohol arthrodesis or fusion? That's about the only option left, to chemically help the fusion along. My internet research has yielded mixed reviews, although that is only anecdotes from various boards FWIW. Seems like I keep coming back to tincture of time but as I mentioned before waiting patiently isn't really my thing.
                            I had my mare's hocks fused via alcohol arthrodesis almost exactly a year ago. She had been intermittently lame with hocks that were *almost* fused but weren't progressing at any rate of speed.

                            Did the whole deal of injecting dye and x-raying to make sure that the joint tracks didn't communicate (very important), and then did one round of injections (4 for the 2 lowers on both sides). My vet said sometimes, a second round can help if the first round doesn't take care of it.

                            The recovery was HARD for me - hearing her walk (popping, grinding) made me cringe , but with pain management, cold hosing/icing, and turnout, she seemed perfectly happy.

                            A year later, she has had no soundness issues (knocking on wood fervently), and her willingness to get to the base of a jump, sit deep and jump around has much improved.

                            Feel free to PM me for more details if you'd like.

                            Comment

                            • Original Poster

                              #15
                              Thanks jackalini, I will PM you.

                              Comment


                              • #16
                                Meaty, the distal tarsal joints can be chemically assisted to fuse. An IA injection of alcohol (most commonly) speeds up the intermediate processes of fusing. It is often recommended for horses with prolonged painful fusing.

                                If those joints are the primary cause of lameness then the horse may be completely sound following fusion (depending on other lameness).

                                On a side note, your vet probably didn't try to inject any HA in the joint. It is uncommon in older horses and particularly when there is reduced joint space. All of the space is needed for a sufficient steroids dose to be effective.

                                Comment

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