Joint Disease Treatment

Joint Disease Treatment

Once the problem joint has been identified, the next step is to formulate a treatment plan. The first option is usually to medicate the joint with corticosteroids in combination with hyaluronic acid. There is often bad press given to the use of corticosteroids in horses, but the doses that are regarded as protective to the cartilage in the joint pose little risk of much talked about side effect of laminitis. Inappropriate use of corticosteroids in terms of dose rate and injecting too many joints at one time may result in problems but using corticosteroids would be regarded as routine by myself and many other vets. Corticosteroids cannot be used near the time of competition or the horse will come up positive on a drug test. As such we obey a withdrawal period, which depends on which drug is used. This means that horses that have repeated problems with joints and need medication to help also need a treatment plan worked out based on their competition schedule.

Arthroscopic surgery is an option for chronically diseased joints and is often carried out outside the competition season to allow time for recovery after the surgery. Shockwave can be a very valuable tool for treating some joints such as the flat weight bearing joint of the hocks, where chronic inflammation is called spavin. It is not completely clear how shockwave works, however it does have a desensitizing effect as well as stimulating blood flow by sending acoustic shockwaves through the tissue. Shockwave can also be a useful treatment for ligamentous problems around the joints.

When I am evaluating a horse with a joint problem an assessment of the foot balance is also made, and any findings are discussed with the yard farrier. Often, altering the shoeing will alleviate pain from within a joint, this is often the case with the hind feet and hock pain. It is also worth involving the physiotherapist in the treatment plan, as horses with chronic joint pain will have upper limb and back stiffness issues. The use of glucosamine based food supplements is a useful adjunct to the management of all sports horses, regardless of whether they have joint problems or not.

The key to managing a competition horse in terms of performance is not to wait until the horse is showing signs of lameness, but to identify subtle problems that can be affecting their performance and act before they become a bigger issue.

Laminitic Horse

Caring for the Laminitic Horse

(By Ed Lyall, BVetMed, CertEM (StudMed), MRCVS)

Laminitis is a painful condition involving inflammation of the laminae. In severe cases the laminae become inflamed all around the hoof resulting in uniform separation, when the limb is loaded the whole pedal  bone then ‘sinks’ within the hoof. The prognosis following rotation is much worse; radiographs are useful to identify what had actually happened.

Causes

There are several reasons why laminitis occurs and it is important to identify the cause so treatment can be carried out accordingly;

1. Equine metabolic syndrome (EMS) which is effectively a form of insulin resistance.
2. Cushing’s disease which many older horses and ponies are now diagnosed with.
3. Some form of sepsis or infection that result in the release of toxins within the body, such as colitis, colic surgery or retention of a portion of the placenta after foaling. Grain overload also falls into this category as the change in diet results in abnormal toxin producing bacteria colonising the gut.
4. Excessive loading of one limb due to injury to the opposite limb. 
5. Excessive exercise on hard ground.

Clinical Signs

Laminitis affects the front limbs more commonly that the back limbs, but one foot can be affected or even just the hind feet. The typical signs of laminitis include;

1. Abnormal stance – usually with the weight rocked back onto the heels and toes out in front off-loading the weight from the more painful toe region.
2. Often cases look very awkward on their hindlimbs, but this is a result of more load being taken by the back end.
3. Walk is reluctant with a toe slapping gait, where the heel is loaded before the toe. There will often be stiff, stilted gait when turning sharply on a hard surface.
4. Often soft footing will be favoured by the patient. Severe cases will lie down and be reluctant to get up.
5. From a clinical point of view the hoof capsule may be hot with a strong pulse palpable in the palmar digital arteries at the back of the fetlock and there will be a pain response on hoof tester pressure in the toe region.

If laminitis is suspected, the first thing to do is make sure there is a deep soft bed, administer pain killers in the form of phenylbutazone if available and then contact a vet for assistance. Laminitis is in many cases an emergency.

Treatment

This will comprise of the following:

1. Removal of shoes, shortening the toe to reduce the rotating effect of the deep digital flexor tendon.
2. Some form of frog support will then need to be applied, and this is to off load the weight from the painful hoof wall. 
3. If we know there has been a toxic episode then icing the feet can reduce the blood supply and prevent further toxins from reaching and damaging the laminae further.
4. Over the years many products have been tried to affect blood flow to the laminae, such as ACP and an ointment form of trinitroglycerine.
5. Phenylbutazone or a derivative is the main pain relief used.
6. Appropriate levels of exercise depending on response to therapy, initially strict rest, then more comfortable turn out in a small paddock may be allowed.
7. Once the initial laminitic incident is under control, then there are a multitude of types of shoes that can be applied to the feet from egg and heart bar shoes, reverse shoes, four point shoes with rails to clogs. The clogs have saved many horses’ lives recently and again are my favoured transition from strap on pads to more normal shoes.

Donkeys Come To AEH

“Freddie” (brown donkey) was admitted to The Arundel Equine Hospital in June for investigation of a mass. On the 12th June “Freddie” was referred for surgery; a segmental postototomy was performed on the distal aspect of the prepuce and the mass suspected sarcoid (melanoma) was removed.

Recovery from anaesthesia was excellent and following recuperation at the hospital “Freddie” along with his trusted friend “Tallulah” are now residing at The Donkey Sanctuary in Sidmouth, enjoying life by the sea.

"Freddie" (pictured right) and "Tallulah" with nurses Emma Poucher and Alanna Baker

September News

It has been a busy summer at The Arundel Equine Hospital; the stud vets have been no stop working with sport horse and racehorses during the breeding season.  There have been some interesting cases coming through the hospital and we have had vets attending race meetings at Goodwood, Brighton and Fontwell (a total of 45 meetings during the summer months) and covering the two International meetings at Hickstead. Rob van Pelt also attended Burghley Horse Trails. Alongside these fixtures we have provided veterinary cover for numerous local Pony Club and Riding Club events, South of England Show, point to points, polo matches etc. across the counties, not to mention delivering the regular 24/7 service.

Summer 2014 has seen a few changes to the Practice, we say goodbye to two of our Veterinary Assistants; Helen Webster, who on route to Ireland, is spending a stud season in Australia, and Sarah Allen, who is going to study a Masters in Epidemiology. We also say goodbye to intern, Camilla Woodward. We wish you all the very best of luck and you will be missed greatly. Which takes us to welcome two new Veterinary Assistants to the fold, Chris Baldwin, who will be working in the South of the Practice, Chris has recently finished a 2 year internship at Newmarket Equine Hospital and, Emma Davis, who will be working in the North of the Practice and has returned South from spending 2 years working in Scotland. We also welcome Andrea Giavitto as the new hospital intern.

VWH – 20th July

Vet's with Horsepower

We left Sandefjord early on Thursday morning to cross on the Moss ferry into Sweden. After a brief stop for coffee with Svein we had a long ride down through Sweden eventually crossing from Malmo to Copenhagen over the 8km bridge. We arrived to a great reception from Denis and Gaby from Copenhagen university and their family and were entertained well at their lovely cottage. On Friday morning we headed into the college equine site for a day of lectures, well attended by the Danish horse vets. We also received a tour of the college campus to view their surgical facilities and have a look at some of the inpatients, both horses and lambs! 

On Saturday morning we left once again this time on a final stretch home. All motorway again across Denmark to Esbjerg where we picked up the ferry to Harwich in England. From here everyone departed to home.

It has been a great experience to be involved in the Horsepower tour this year. During the trip it was explained to the delegates just where their donations have been going. For just £150 the Smile train charity can help repair children with cleft palates who without the opportunity are often unable to get ahead in any form of their lives and often die prematurely living in squalor. By saving donkeys in Gambia we stop the young children having to carry the water daily instead. It feels a privilege to have been involved and I've been left with a real sense of trying to give something back. Together we have raised over £95000 for the two charities.
Just need to try to avoid sitting down for a week or two! 
Andy

VWH – 17th July

Thursday 17th July

Every now and then something extraordinary happens that reminds us of just how amazing people can be. We were lucky enough to be part of an incredible act of individual and collective generosity last night at the Norwegian lectures. In an emotional speech which had almost everyone in the room in tears at end of the lectures, the incredibly charismatic and unbelievably dedicated and hard working local organiser Dr Svein Bakke presented a cheque for a massive £20,000 (211,000 Kr) to the Vets with Horsepower team. This huge amount of money was raised by the Norwegian delegates (who paid to see the lectures) and from sponsorship raised by Dr Bakke (the sponsors can be found on the Vets with Horsepower Facebook page and the Virgin Money Giving site). This is the largest donation from any venue we have visited and takes the total raised for Smile Train and The Gambia Horse and Donkey Trust to over £80,000!

To put the Norwegian donation into context, this is enough to pay for life saving cleft palate and hair lip surgery on 100 children and vaccinate 2,500 horses or donkeys against tetanus. Go Svein, Go Norway and Go Horsepower!