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Talk to me about alternatives to hock injections: IRAP? Tildren? Others?

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  • Talk to me about alternatives to hock injections: IRAP? Tildren? Others?

    My horse is starting to tell me he wants a little more help with his hocks. (He gets an HA joint supplement daily, Ichon every six weeks, and Legend twice or three times a year, or as needed.) He had hock injections about a year and a half to two years ago but I am curious about newer options that could take the place of joint injections. My vet mentioned IRAP therapy as an option, and a friend's vet had mentioned the drug Tildren as a useful IV drug for hocks. Does anyone have any experience with these two therapies, or any other that has been successful in increasing comfort and mobility in arthritic hocks?
    Last edited by Renn/aissance; Jan. 21, 2009, 04:17 PM.
    "I'm not always sarcastic. Sometimes I'm asleep." - Harry Dresden

    Amy's Stuff - Rustic chic and country linens and decor
    Support my mom! She's gotta finance her retirement horse somehow.

  • #2
    Great article about Tildren in this week's COTH.
    Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

    Remember the horse does all the work, we just sit there and look pretty.


    • #3
      I consider my horse an IRAP sucess story. She went to surgery in June 07 to remove a chip in the left fore fetlock, and two depo deposits were discovered in the joint and debrided at that time. One had healthy cartilage beneath, and one had failing cartilage and failing bone underneath and was debrided down to healthy bone.

      Blush was very sore after surgery and continued to be very sore. IA HA made her comfortable for about 6 weeks. We started the IRAP series in Oct 07, finished it in Nov 07 and she had been comfortable and sound on that joint since.

      I do wonder, though, with just what you've written above, if doing Legend and Adequan monthly with your horse would provide enough "oomph" to make him more comfortable. I would probably try upping your injectibles before pulling out the big guns of IRAP and/or Tildren.


      • Original Poster

        The current Legend and Adequan schedule was suggested by my former vet; since relocating to a new area I have been using a different vet, whom I trust equally. I'm going to sit down with this vet to re-evaluate his maintenance schedule and see how we can best help him be comfortable, as he very clearly loves his job and is otherwise fit and healthy!

        Having done more research on IRAP I am not sure that it is the best option, both because it seems more invasive (more needles, more IA injections) and because of the cost. I was not able to find a cost for Tildren but have heard that it will be pricey, not to mention I will probably need to ship him to an equine hospital to have it done. (Then again, as of right now, if Tip wants his hocks done before May I'll be shipping him out anyway because current vet does not do IA injections.)

        Are there alternate therapies that in your experiences have proved effective?
        "I'm not always sarcastic. Sometimes I'm asleep." - Harry Dresden

        Amy's Stuff - Rustic chic and country linens and decor
        Support my mom! She's gotta finance her retirement horse somehow.


        • #5
          Originally posted by Renn/aissance View Post
          Are there alternate therapies that in your experiences have proved effective?
          Surpass. I use it Blush's "bad" fetlock and "bad" hock daily. I absolutely think that it's helped with both. Frisbee even showed that using Surpass daily improves the cartilage matrix.


          • Original Poster

            How do you feel that Surpass stacks up in relation to other therapies available? Do you feel that it could prolong the interval between injections?
            "I'm not always sarcastic. Sometimes I'm asleep." - Harry Dresden

            Amy's Stuff - Rustic chic and country linens and decor
            Support my mom! She's gotta finance her retirement horse somehow.


            • #7
              Yes, absolutely, I do think it prolongs the time between injections. I find it very useful.

              This summer, when we were figuring out what was wrong with Blush, I wasn't riding, so I didn't Surpass. Within a week or so, the fetlock started clicking when I picked up her foot. A few days of Surpass and it went back to normal. I have no idea if the clicking coincided with lameness in the leg, but it creeped me out. Now I continue to Surpass even if she's laid off.

              My protocol with Blush is as follows:

              Surpass on the fetlock and the hock daily.
              Adequan on the 1st of every month.
              Legend on the 15th of every month.
              Work 6 times a week.

              It's been over a year (knock wood) since we've had to do anything to the fetlock, and several months on the hock (that, along with the cervical spine, were our issues this summer.)

              Blush just had a lameness exam a couple weeks ago and the vet said she looked fantastic. This is what works for us.


              • #8
                It's probably cheaper and easier, and equally or possibly more effective to just inject the hocks. Afterwards I would adjust your Legend program and/or possibly add Adequan to prolong the comfort, but nothing has the same effect as going into the joint when they actually need it.

                This is somewhat off-topic, but I've noticed this trend in other posts:
                I don't mean this to be critical, just curious, but don't you consider applying Surpass daily as almost the equivalent of daily Bute? It seems people are very willing to consider one but highly critical of the other, when they're both an NSAID. I realize there is slightly less risk of adverse effects due to the method of application, but it still seems like people consider Surpass a treatment and Bute just a painkiller. I'm curious as to whether that's linked to it being a topical or if there are other considerations.


                • #9
                  With regard to daily Surpass:


                  So, yes--it's an NSAID. But it also has a positive effect on the joint. Systemic absorption is low (I've read 3%.) I think it's an excellent tool for horses with joint issues. I consider it a treatment because it *is* a treatment.


                  • #10
                    what about shoes? heel extenders are good for hock issues.. they give more support



                    • #11
                      In order to make the time between hock injections as long as possible, I use both Adequan and Legend. Right now, I give Adequan injections every three weeks, sometimes substituting Legend for the Adequan. In a perfect world, my vet said I could alternative between Legend and Adequan every two weeks. I don't think giving Legend two or three times a year really would go much to stave off the need for hock injections. In my case my vet calls in the prescriptions online and I administer, so there is no vet call. Adequan is particularly cost effective when compared to oral sups (which may or may not work). I'd encourage youto increase your Legend and Adequan shots before spending the bigger bucks on IRAP etc.

                      (I do have Surpass to try in the future, too, but haven't yet needed it.)

                      PS -- My mare is 16 and ridden 5 times a week.


                      • Original Poster

                        what about shoes? heel extenders are good for hock issues.. they give more support
                        I will bring that idea up to my farrier, thank you!

                        It looks like we'll be going with hock injections, and as soon as we can get them--Mr. Tip was not very comfortable yesterday and didn't work out of it as well as I would have liked. He wanted to work, but just didn't want to push off behind. I'll discuss Surpass with my vet for the future. Thank you everyone for your suggestions!
                        "I'm not always sarcastic. Sometimes I'm asleep." - Harry Dresden

                        Amy's Stuff - Rustic chic and country linens and decor
                        Support my mom! She's gotta finance her retirement horse somehow.


                        • #13
                          Renn, I completely forgot about extended hind shoes. Has left my memory entirely. When I was showing Splash, we used a curved extension on his hind shoes. Made a huge difference in the use of his hind end.

                          \"If you are going through hell, keep going.\" ~Churchill~