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Joint injections without X-Rays?

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  • #21
    Maybe because repeated joint injections can eventually degrade the joint itself...and the fact that any time you stick a needle into a joint capsule there is the remote chance of sepsis. Especially if it is done on a farm site and not in a more aspectic environment

    Untreated DJD is what will degrade the joint and at a lot faster rate than any injection! Sure there is a very small risk of infection but for many horses there really is no better option. I just don't understand this mentality, so what, just ride the horse around stiff and sore? If you are asking your horse to be an athlete he needs to be treated as one...anything else is simply unfair. I am not advocating injection of totally healthy joints but if you have a serious performance horse you are going to be injecting to maintain that horse's joint health at some point or you are riding a horse that needs help and you are either unaware or choosing to ignore it (or you have a freak of nature). Go to any show though and I think it is pretty obvious which one of the two options is by far the most common. And you gotta love the people who proudly claim their 17 year old schoolmaster "has never needed injections" as the horse is dragging a hind leg around the arena. A person just sees this ALL the time.
    www.svhanoverians.com

    "Simple: Breeding,Training, Riding". Wolfram Wittig.

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    • #22
      Originally posted by Donella View Post
      Maybe because repeated joint injections can eventually degrade the joint itself...and the fact that any time you stick a needle into a joint capsule there is the remote chance of sepsis. Especially if it is done on a farm site and not in a more aspectic environment

      I just don't understand this mentality, so what, just ride the horse around stiff and sore? If you are asking your horse to be an athlete he needs to be treated as one...anything else is simply unfair.
      I'm sorry I wasn't clear. We stop riding the horse at this point.
      www.littlebullrun@aol.com See Little Bull Run's stallions at:
      "Argosy" - YouTube and "Boleem" - YouTube
      Boleem @ 1993 National Dressage Symposium - YouTube

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      • #23
        I'm sorry I wasn't clear. We stop riding the horse at this point.

        Generally speaking though I am not talking about an overtly lame horse, I am talking about a horse that just likely isn't using himself as well as he could if he had a bit of help (what I call stiff or just not quite right without being called lame by anyone). In reality most people either don't feel this change in their horse so maybe that is why these things get left? Heck so many people obviously don't notice overt lameness so really.... Anyways, these small changes often happen under the age of ten years old in performance horses so I would assume that most people don't want to just retire a horse simply because he is just not using himself as well as he could or because he has the beginnings of DJD. That generally isn't something that warrants retirement but it is something that requires veterinary intervention if you want your horse to last. If you prefer to retire at that point, that is obviously ok too but when keeping the horse tip top is as easy and painless as a simple injection I just can't imagine choosing retirement..but that's just me I guess.
        www.svhanoverians.com

        "Simple: Breeding,Training, Riding". Wolfram Wittig.

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        • #24
          Originally posted by eqsiu View Post
          I do think flexion tests are diagnostic enough, it's just the wire thingy I really don't get. If it moves a certain way by the joint then it's arthritic? I don't understand.
          It sounds like the vet is using some sort of dowsing technique reminiscent of "muscle testing" kinesiology.

          Quack-quack-quack...

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          • #25
            Originally posted by Donella View Post
            I'm sorry I wasn't clear. We stop riding the horse at this point.

            Generally speaking though I am not talking about an overtly lame horse, I am talking about a horse that just likely isn't using himself as well as he could if he had a bit of help (what I call stiff or just not quite right without being called lame by anyone). In reality most people either don't feel this change in their horse so maybe that is why these things get left? Heck so many people obviously don't notice overt lameness so really.... Anyways, these small changes often happen under the age of ten years old in performance horses so I would assume that most people don't want to just retire a horse simply because he is just not using himself as well as he could or because he has the beginnings of DJD. That generally isn't something that warrants retirement but it is something that requires veterinary intervention if you want your horse to last. If you prefer to retire at that point, that is obviously ok too but when keeping the horse tip top is as easy and painless as a simple injection I just can't imagine choosing retirement..but that's just me I guess.
            Sorry again. I'm talking about horses in their mid to late teens.

            I guess I'm lucky. Never had any chronic lameness problems under that age that would require joint injections.

            But then, during high performance work, I used HA IV and Adequan as a preventative.

            Acute situations with an injury, sure, the injection is the way to go to settle down the joint. But I've only had to do that once and the horse went back to work after it had recovered.

            I think we may be talking apples and oranges. IME, if q horse must keep a horse on frequent joint injections to keep it comfortable to work... I retire it.

            If one needs to do that later in their life, that's fine. I never have. I just stop riding them or...if I do I dumb down the work to their comfort level. Luckily I have arenas with superb footing that can be helpful to them as well.

            But frankly, I've never dealt with even thinking about joint injections at the age you are discussing with your horses. Haven't had to nor look to a quick fix. But that's just me.
            www.littlebullrun@aol.com See Little Bull Run's stallions at:
            "Argosy" - YouTube and "Boleem" - YouTube
            Boleem @ 1993 National Dressage Symposium - YouTube

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            • #26
              Originally posted by wildlifer View Post
              See this just isn't true. And if your vet is any good, they are not the ones making the decisions anyway. The owner should be making INFORMED decisions and advocating for the horse's best interest. It is the job of the vet to present the information, not make the call unless the owner so asks.
              Well apparently every boarder at my barn is an idiot, because they trust their vet to provide the information, which is why the vet has the degree and the owner doesn't. If every owner had to go out and research every procedure that was done on their horse, as opposed to trusting their vet (who has the degree and should know some thing about the current research) nothing would ever get done. And aren't I constantly seeing threads on here about owners defying vets with "well I read this, and therefore you shouldn't treat with that!!".
              And most of the research required to make an informed decision in this matter requires knowledge of biology, which most people left behind in the first year of college with Bio 101. They aren't going to know anything about GAGs or PGs or the composition of synovial fluid or even the normal inflammatory process, let alone the inflammation that occurs within a completely avascular tissue.

              Originally posted by Donella View Post
              Corticosteriods can cause degradation if used repeatedly over long periods of time , however there are many different substances that vets will use depending on various factors. It is important to realize that with DJD there is inflammation acting on the joint and that that inflammation acts to destroy the joint if it is not dealt with. Injecting can therefor seriously prolong joint health and slow the progression of DJD via counteracting the inflammation (among other things).
              Methylprednisolone is widely known to have deleterious effects on joint cartilage. I'd be happy to provide scientific articles for anyone who is interested. There are some novel compounds that have been shown to not be as detrimental as MPA, however.
              You are right, that osteoarthritis is widely becoming known as an "inflammation" disease, however it does not exhibit a traditional inflammatory response since articular cartilage is avascular and aneural, and the mechanisms of this process within the chondrocytes are completely unclear.
              The inflammation that the corticosteroids is likely helping is associated with the synovial membrane, not the articular cartilage itself.
              While OA is also becoming known as a "whole joint disease", and therefore by treating the synovium you are helping alleviate the pain (especially since the synovial lining is innervated and therefore can experience pain, unlike articular cartilage), the classic symptom of OA is degradation of the articular cartilage. And right now, there is nothing that slows or stops the process or articular cartilage degeneration, even IA injections. If there was, whoever discovered it would be a freaking billionaire and a Nobel Prize winner.

              Originally posted by sid View Post
              ...and the fact that any time you stick a needle into a joint capsule there is the remote chance of sepsis. Especially if it is done on a farm site and not in a more aspectic environment.
              This is what I take issue with. It is such common practice to inject (perform a surgical procedure!) in a wash stall with minimal prep. And if anyone knows anything about bacteria & synovial fluid, they know how much those bugs thrive in it and how devastating an infected joint is.
              It is not worth the risk IMO for my older horses to squeeze a few more riding years out of them. They get retired from showing, or jumping, or hard riding if they can't be managed with other treatments. But that's my personal opinion and I certainly don't expect everyone else to follow it.

              Back to the matter at hand, the above is why I don't do IA injections without radiographic evidence of end-stage disease that 1) is probably too far gone to be protected and 2) is too far gone for other treatment modalities. If IA injections will provide some relief, then by all means, go for it, but get rads done first!

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              • #27
                There was a fascinating blog by Lauren Sprieser on the COTH page recently about joint injections. It was the first time someone made an argument for joint injections that opened my eyes to why we should do them when the horse needs them. Her vet is Kent Allen.

                Working through a stiff inflamed joint is like driving an engine that's low on oil. Maybe you have a horse with a lot of heart that will work through it, but his joints will age faster.

                Retiring horses young is not all its cracked up to be. I have retired my fair share and I don't want to watch any more of them moping around the pasture with their muscles sagging. My goal now is to keep my horses sound, comfortable and engaged in work that is appropriate to their abilities for as long as possible.

                Not all steroids are equal. Triamcinalone (sp?) has supposedly been shown to be chrondroprotective. Betamethasone is supposed to be neutral. Depo medrol is only for joints that are fusing.

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                • #28
                  Ordinarily, I would want flexions first. If the horse flexed lame, I would want x-rays of whatever I intended to inject, before I inject it. For subsequent injections of the same site, I would want flexions showing soreness, but wouldn't necessarily x-ray each time (although I would want to re-x-ray frequently injected joints every few years).

                  For my horse? Well, he flatly REFUSES flexions of a sore joint. So with him, we base it on his movement on the lunge and under saddle (I have previously x-rayed all joints that we inject on him - hocks, stifles), as well as on the date of his last injections. We do usually at least attempt to flex him, but if he has one positive flexion, he will NOT allow himself to be set up for subsequent flexions again that day.

                  So I guess it is different for every horse. I have never injected this horse and felt like it was the wrong decision.

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                  • #29
                    Originally posted by Helicon View Post
                    There was a fascinating blog by Lauren Sprieser on the COTH page recently about joint injections. It was the first time someone made an argument for joint injections that opened my eyes to why we should do them when the horse needs them. Her vet is Kent Allen.

                    Working through a stiff inflamed joint is like driving an engine that's low on oil. Maybe you have a horse with a lot of heart that will work through it, but his joints will age faster.

                    Retiring horses young is not all its cracked up to be. I have retired my fair share and I don't want to watch any more of them moping around the pasture with their muscles sagging. My goal now is to keep my horses sound, comfortable and engaged in work that is appropriate to their abilities for as long as possible.

                    Not all steroids are equal. Triamcinalone (sp?) has supposedly been shown to be chrondroprotective. Betamethasone is supposed to be neutral. Depo medrol is only for joints that are fusing.
                    Interesting about Kent Allen. He was brought in to consult on my stallion Boleem after his accident on the phantom at Hilltop (a few days after I bought him...go figure..), and I brought him home after 3 months in a frozen semen collection quarantine.

                    After that happened at Hilltop -- freak breeding shed accident, he came off catywampus -- he'd be sound for days (Scott and Suzanne were keeping him in work), then after about 5 days of work he'd be "slightly" off. They and I took the conservative route with their attending vet, Midge Leitch.

                    The figured it was the ankle the way he fell, but they did not inject him because they could not pinpoint the exact nature of the injury. Nothing was showing up on rads or ultrasound. Recall he was an FEI long listed horse. If he was booted up with a joint injection, with his willingness to work, he could have done more damage in their professional opinion. I think that was prudent.

                    The point was...they/we wanted to pinpoint the problem before going that route.

                    When I got him home, he demonstrated the same pattern. 5 days superb, then slightly off (grade -1). So we stopped work and with almost 3 mos. of this pattern, I took him to Morven Park (Va Tech vet school EMC) for continued diagnostics.

                    Xeroradiographs showed a subchondral bone defect at the top of P1. Was SO close to the joint, no one could tell if the joint surface was actually affected (no MRIs in those days). As I learned from that experience, it takes awhile with even a mild, but acute injury to see it on rads. They DID inject the joint at that time. But it was the only time.

                    For his rehab, I consulted Kent, who came to my farm to evaluate him and suggested electromagnetic therapy boots (through his partner), which we did diligently every day. No turnout for about 4 months. Just hand walking in the indoor. Thank God, Bo was a gem of a horse.

                    We were looking for healing (if possible). He was only 13 at that time. And he did recover with patience and prudence. Even the vets at Morven, where I would take him for new rads about every 6 weeks, were astounded.

                    In my mind, having gone through that experience, patience was the key. Sure there were many that thought because he was a top horse, to just inject and keep him going. But unless we actually diagnosed, that would have been a crapshoot. Because he was such a worker bee, the injections could have masked and thwarted his recovery.

                    Clearly, there are probably many better IA drugs that there were then. But still..I always prefer to diagnose as the risk of joint sepsis is always there. In fact my vet of 15 years, who referred Bo to Morven, will not inject on site for that reason.

                    Joint infections are not common for sure, but if you've seen that "helping" by injecting on site go south...well, I couldn't live with that. My first foal had joint ill and I lost him.

                    I've seen vets and owners just that pop it in, but never bother to diagnose. Just make them comfy and keep them going. I'm science head, so of course that bothers me.

                    Frankly, all my my horses over these years have never "limped" around the field without injections. Maybe I've been lucky.

                    Sorry so long. We all have our preferences and my experience with Bo have guided mine with other horses since then. We always diagnose first, then treat. But that's just me.

                    For acute joint injury assaults...you bet. After that, not so sure. But then I'm an old timer.
                    www.littlebullrun@aol.com See Little Bull Run's stallions at:
                    "Argosy" - YouTube and "Boleem" - YouTube
                    Boleem @ 1993 National Dressage Symposium - YouTube

                    Comment


                    • #30
                      My vet did not shoot x-rays on my mare. She was "stiff" and just felt wrong to me at the end of the season even though vet said she was sound. Got her adjusted by chiropractor and she starts missing changes behind (She has never missed in her life!) That is when I knew something was up. Vet watched me ride her through the changes (more one than the other) and injected. It has been over a year and she feels so much better.

                      The same day he injected my mare he also injected our pony. She was an off again on again retiree and 3 vets could not diagnose her correctly. My vet took x-rays and sees an arthritic hock (the other one strangely perfect). She was injected and is now over a year later happily carting little kids around the leadline, mini, and short stirrup ring.

                      I was against injections before this but for them now if they are called for. I see no reason to inject a healthy joint or if the vet does not 100% suspect it is the joint to do other testing. It worked out for the better for both horses.
                      "People who think their brains are not worth protecting are probably right!"
                      - quoted by Martha Drum

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                      • #31
                        But frankly, I've never dealt with even thinking about joint injections at the age you are discussing with your horses. Haven't had to nor look to a quick fix. But that's just me.

                        Hey, don't get me wrong, I am not saying this is a regular occurrence in all performance horses under the age of ten. But it isn't uncommon either as I have discovered in my experiences with high performance dressage horses (most of which were not mine, btw). FWIW , a friend of mine (who was also a team rider for Canada) was married to vet who treated many of the worlds top dressage horses in the 80's and 90's as he was hailed as an expert with the injections (hence the reason they sought him out). Injections certainly played a role in keeping many of these top horses performing at that level and for the length of time that they did (at least the vet and riders felt that way).

                        We also start ours on regular Adequan shots at five years old and up and also know the value of good footing, shoeing ect which no doubt works as a preventative assuming the horse has normal conformation. Obviously if you are having to inject on a very regular basis it is time for the horse to retire but I do believe that many people will ride a horse that needs some help because they have an aversion to joint injections. That is what I take issue with.
                        www.svhanoverians.com

                        "Simple: Breeding,Training, Riding". Wolfram Wittig.

                        Comment


                        • #32
                          Originally posted by Donella View Post
                          We also start ours on regular Adequan shots at five years old and up and also know the value of good footing, shoeing ect which no doubt works as a preventative assuming the horse has normal conformation. Obviously if you are having to inject on a very regular basis it is time for the horse to retire but I do believe that many people will ride a horse that needs some help because they have an aversion to joint injections. That is what I take issue with.
                          Agree totally.
                          www.littlebullrun@aol.com See Little Bull Run's stallions at:
                          "Argosy" - YouTube and "Boleem" - YouTube
                          Boleem @ 1993 National Dressage Symposium - YouTube

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