Spotting Lameness: The Game Plan
— Read on horsenetwork.com/2018/10/spotting-lameness-game-plan/
Spotting Lameness: The Game Plan
Spotting Lameness: The Game Plan
— Read on horsenetwork.com/2018/10/spotting-lameness-game-plan/
Over the past 30 years the Grayson-Jockey Club Research Foundation has funneled nearly $20 million into studies aimed at improving horse health. This year the effort continues with funding for a dozen new projects in fields ranging from laminitis to lameness diagnosis. A sampling:
Detecting lameness at the gallop: Kevin Keegan, DVM, of the University of Missouri, is developing an objective method (using a calibrated instrument) for detecting obscure, subtle lameness in horses at the gallop. The goal is a low-cost method that can be used in the field to increase understanding of lameness in racehorses.
Deworming and vaccines: While it’s not unusual to deworm and vaccinate horses on the same day, recent findings have raised concerns about possible interactions. Martin Nielsen, DVM, of the University of Kentucky and Gluck Equine Research Center, is investigating whether deworming causes an inflammatory reaction that affects vaccination.
Imaging injured tendons: Horses recovering from tendon injuries are often put back to work too soon and suffer re-injury. Sabrina Brounts, DVM, of the University of Wisconsin–Madison, is exploring a new method developed at the university to monitor healing in the superficial digital flexor tendon. The technique, called acoustoelastography, relates ultrasound wave patterns to tissue stiffness: Healthy tendon tissue is stiffer than damaged tissue.
Detecting laminitis early: Hannah Galantino-Homer, VMD, of the University of Pennsylvania, is investigating possible serum biomarkers (molecular changes in blood) that appear in the earliest stages of laminitis. The goal is to develop tests for these disease markers so that treatment can start when laminitis is just developing, before it’s fullblown and damages the foot.
Other new studies include evaluations of a rapid test for salmonella; investigation of how neurologic and non-neurologic equine herpesvirus 1 (EHV-1) spreads cell-to-cell in the body; an effort to map the distribution of stem cells after direct injection into veins; and more.
This article originally appeared in the June 2013 issue of Practical Horseman.
For the past 6 weeks, my horse has been receiving Ozonetherapy to aid in his chronic back leg related issues- dermatitis (“scratches”), previous DDFT tendon laceration, a history of Lymphingitis, and the residual scar tissue from his DDFT injury. Due to his age (27), he lacks proper circulation in his hind end which does not help him fight his pastern dermatitis.
According to the American Academy of Ozonetherapy, Ozonetherapy is described as;
“Ozonotherapy is the use of medical grade ozone, a highly reactive form of pure oxygen, to create a curative response in the body. The body has the potential to renew and regenerate itself. When it becomes sick it is because this potential has been blocked. The reactive properties of ozone stimulate the body to remove many of these impediments thus allowing the body to do what it does best – heal itself.”
“Ozonotherapy has been and continues to be used in European clinics and hospitals for over fifty years. It was even used here in the United States in a limited capacity in the early part of the 20th century. There are professional medical ozonotherapy societies in over ten countries worldwide. Recently, the International Scientific Committee on Ozonotherapy (ISCO3) was formed to help establish standardized scientific principles for ozonotherapy. The president of the AAO, Frank Shallenberger, MD is a founding member of the ISCO3.”
“Ozonotherapy was introduced into the United States in the early 80’s, and has been increasingly used in recent decades. It has been found useful in various diseases;
After doing research and speaking to one of my good friends, we determined that Chance’s flare up of Lymphingitis, after almost 3 years of not a single issue, could possibly be caused by his immune system’s response to Ozonetherapy. Let me explain.
Chance suffers from persistent Pastern dermatitis (“scratches”) since I purchased him in 2000. I have tried everything- antibiotics, every cream and ointment and spray for scratches, diaper rash ointment, iodine and vaseline mix, Swat, laser treatments, scrubs and shampoos, shaving the area, wrapping the area, light therapy…you name it, I have tried it. So, when we began Ozonetherapy to help break down the left over scar tissue from his old DDFT injury, I noticed that his scratches were drying up and falling off. We continued administering the Ozonetherapy once a week for about 6 weeks. The improvement was dramatic!
However, one day Chance woke up with severe swelling in his left hind leg and obviously, he had difficulty walking. He received Prevacox and was stall bound for 24 hours. The vet was called and she arranged to come out the following day. The next morning, Chance’s left leg was still huge and he was having trouble putting weight on it. I did the typical leg treatments- icing, wrapping. The swelling remained. I tried to get him out of his stall to cold hose his leg and give him a bath but he would not budge. He was sweaty and breathing heavily and intermittently shivering. So, I gave him an alcohol and water sponge bath and continued to ice his back legs. I sat with him for 4 hours waiting for the vet to arrive. He had a fever and wasn’t interested in eating and his gut sounds were not as audible. He was drinking, going to the bathroom, and engaging with me. I debated giving him Banamine but did not want it to mask anything when the vet did arrive.
The vet arrived, gave him a shot of Banamine and an antihistamine and confirmed that Chance had a fever of 102 degrees and had Lymphingitis. There was no visible abrasion, puncture, or lump… I asked the vet to do x-rays to ensure that he did not have a break in his leg. The x-rays confirmed that there was no break. The vet suggested a regiment of antibiotics, steroids (I really am against using steroids due to the short-term and long-term side effects but in this case, I would try anything to make sure he was comfortable) , prevacox, and a antacid to protect Chance from stomach related issues from the medications. It was also advised to continue to cold hose or ice and keep his legs wrapped and Chance stall bound.
The following day, Chance’s legs were still swollen but his fever had broken. The vet called to say that the CBC had come back and that his WBC was about 14,00o. She suggested that we stop the steroids and do the antibiotic 2x a day and add in Banamine. I asked her if she could order Baytril (a strong antibiotic that Chance has responded well to in the past) just in case. And that is what we did.
Being as Chance had such a strong reaction to whatever it was, I did some thinking, discussing, and researching…first and foremost, why did Chance have such an extreme flare up of Lymphingitis when he was the healthiest he has ever been? And especially since he had not had a flare up in 3+ years…plus, his scratches were getting better not worse. The Ozonetherapy boosted his immune system and should provide him with a stronger defense against bacteria, virus’, etc. So why exactly was he having a flare up? And that is when it hit me!
In the past when Chance began his regiment of Transfer Factor (an all natural immune booster), he broke out in hives. The vet had come out and she felt it was due to the Transfer Factor causing his immune system to become “too strong” and so it began fighting without there being anything to fight, thus the hives. My theory- Chance started the Ozonetherapy and his body began to fight off the scratches by boosting his immune system. As the treatments continued, his immune system began to attack the scratches tenfold. This resulted in his Lymphatic system to respond, his WBC to increase, and his body temperature to spike. Makes sense…but what can I do to ensure this is not going to happen again?
My friend suggested attacking the antibiotic resistant bacteria by out smarting them…okay, that seems simple enough…we researched the optimal enviroments for the 3 types of bacteria present where Chance’s scratches are (shown in the results of a past skin scape test). The bacteria – E. Coli, pseudomonas aeruginosa and providencia Rettgeri. The literature stated that PA was commonly found in individuals with diabetes…diabetes…SUGAR! How much sugar was in Chance’s feed? I looked and Nutrina Safe Choice Senior feed is low in sugar…so that is not it. What else can we find out? The optimal temperature for all three bacteria is around 37 degrees celsius (or 98.6 degrees fahrenheit), with a pH of 7.0, and a wet environment. Okay, so, a pH of 7.0 is a neutral. Which means if the external enviroment (the hind legs)pH is thrown off, either to an acidic or alkaline pH, the bacteria will not have the optimal enviroment to continue growing and multiplying. How can I change the pH?
Vinegar! An antimicrobial and a 5% acetic acid! And…vinegar is shown to help kill mycobacteria such as drug-resistant tuberculosis and an effective way to clean produce; it is considered the fastest, safest, and more effective than the use of antibacterial soap. Legend even says that in France during the Black Plague, four thieves were able to rob the homes of those sick with the plague and not become infected. They were said to have purchased a potion made of garlic soaked in vinegar which protected them. Variants of the recipe, now called “Four Thieves Vinegar” has continued to be passed down and used for hundreds of years (Hunter, R., 1894).
I went to the store, purchased distilled vinegar and a spray bottle and headed to the farm. I cleaned his scratches and sprayed the infected areas with vinegar. I am excited to see whether our hypothesis is correct or not…I will keep you posted!
References & Information
Your horse comes in from being outside and is barely able to move. His legs are swollen, he has a fever, is sensitive to the touch, and has a loss of appetite. He has chills- intermittently shaking. He wont touch his hay, his eyes are dull, and he looks depressed and tired. You call the vet and they run hundreds of dollars worth of tests- CBC, x-ray his legs to ensure there is no fracture; they diagnose him with Lymphingitis. You begin a course of antibiotics. You cold hose. You give him Banamine. Your wrap his legs while he is on stall rest. A week later, the swelling has subsided, his fever has dissipated, and his appetite is back.
You get a text saying that your horse “ran away” when he had been let out earlier that day. But when you get to the barn, you notice when he turns he looks like his hind end is falling out from under him..remember when you were little and someone would kick into the back of your knees and your legs would buckle? That is what it looks like. So you watch him. You are holding your breath, hoping he is just weak from stall rest. You decide, based on the vet’s recommendation, to let him stay outside for the evening. You take extra measures- leaving his stall open, with the light on, wrapping his legs, etc- and go home. Every time your mind goes to “what if..”, you reassure yourself that your horse is going to be okay and that you’re following the vet’s advice and after all, your horse had been running around earlier that day.
The next morning your horse comes inside and it takes him an hour to walk from the paddock to his stall. All four legs are swollen. He has a fever (101.5). He is covered in sweat. He won’t touch his food. He has scrapes all over his body and looks like he fell. You call the vet- again- and they come out to look at him. They note his back sensitivity, his fever, the swelling at his joints (especially the front). They note that his Lymphingitis seems to have come back. The vet draws blood to check for Lyme. They start him on SMZs and Prevacox. You once again wrap his legs, ice his joints, give him a sponge bath with alcohol and cool water to bring down his fever. You brush him, change his water, put extra fans directed at his stall. You put down extra shavings. And you watch him.
A few days go by and you get a call saying that your horse has tested positive for Lyme…and while your heart sinks, you are also relieved that there is an explanation for your horse’s recent symptoms. You plan to begin antibiotics and pretty much not breathe for the next 30+ days while your horse is pumped with antibiotics. You pray that he doesn’t colic. You pray that you have caught Lymes in time. You pray that the damage is reversible. You research everything you can on the disease. And you sit and wait….
Below are resources on Lyme Disease in horses- treatments, symptoms, the course of the disease, and the prognosis.
Today Chance had swelling of his back right fetlock. He had a fever around 104 and didn’t eat his feed. His eyes were dull and he was lethargic. He wasn’t limping but was walking slower than normal (he usually runs to the paddock or back to the barn). I decided, due to the Lymphingitis flare up on his back right leg, I would give him a shot of 5 mls (or 5 cc) of Banamine and wrap his leg. Once the medication set in, I would bring him in to give him a bath (it was 80 degrees today). So, that is what I did. By the time he was back at the barn he was covered in sweat. I cold hosed him and drenched the wrap in cool water and let him roam around the barn.
Thankfully, the vet was able to meet me at her veterinary practice so that I could pick up Baytril and more Banamine. Since Chance just had Lyme Disease (and had finished his medication less than a week ago), we are not 100% if this is a Lyme reaction or something else. The plan is to administer 25 cc of Baytril either orally, in his feed, or via IV for 6 days and Banamine 10 mls (or a 1000 lbs) twice a day for 3 days. The vet suggested that I do 5 cc of Banamine if his fever remains between 101-103 degrees and 10 cc if his fever is 103 degrees or above. During this time I will begin Prevacox- one 1/4 of a tablet once a day. After 3 days, I will discontinue the Banamine and continue the Prevacox. If his fevers are not down in two days, I will continue the Baytril but start the doxycycline as it maybe a Lyme disease symptom.
While researching Lyme Disease, I found that many people do two+ months of doxycycline instead of 30 days to ensure the disease has been erraticated completely. However, since Chance had shown such improvement after 30 days, I decided to not do another month. Maybe I should have…
However, Chance had similar symptoms when we found a small laceration in the DDFT tendon of his back left hind- swelling, Lymphingitis, fever, lethargy, no appetite, etc. If he does have an issue with his tendon I will most likely do another round of Stem Cell treatments which proved to be helpful last time. Thankfully I stored his stem cells in a Stem Cell Bank (via Vet-Stem) and can easily have them shipped.
During my horse’s recent Lymphingitis flare-up, the vet advised that we run labs to test for Lyme and EPM due to his presenting symptoms (hind weakness, twisting his back leg at the walk/walking sideways I refer to it as- “Chance’s swagger”). As I noted previously, Chance’s Lyme test revealed that he was at the beginning stages of an acute infection…yay for the labs at Cornell University for their amazing ability to give you more than a positive or negative!
A little history before getting to the EPM Tilter results.
About 2ish years ago, Chance was diagnosed with EPM (and one of the reasons opossums and I are not friends since they host the disease as do a few other culprits). Chance immediately began EPM treatment- he received Protazil in his feed for one month. After hours of research I chose Protazil, although extremely expensive (if you order from http://www.drfosterandsmith.com they sometimes have promotions where you receive store credit for every $100.00 you spend…they did when I ordered and I got a “free” dog bed that my dogs adore), due to the decreased likelihood of Chance experiencing a “Treatment Crisis” (worsening of symptoms) and the ease of administration (other brands require the drug being administered 1 hour before eating or an hour after and so on). Typically, EPM treatment is done for 30 days and, depending on the residual symptoms, some may require subsequent treatments. While Chance’s symptoms improved, I wanted to ensure that we annihilated the disease and did another round of treatment but this time with Marquis. At the end of two months, Chance’s ataxia was gone!
Fast forward to September 2016…Chance, just having a Lymphingitis flare-up, has been tested for Lyme and EPM. Lyme came back positive. And….so did the EPM test..well, kind of. Wonderful. (See why I loathe opossums?)
Chance’s EPM test #2 on 8/30/16 (the 1st one was 2ish years ago) showed the following:
“Combined SAG 2,3,4 Tilter on serum= 1:2000”
So, what does this mean?
The test revealed that Chance had “positive, specific antibodies” detected in the blood work. This means that he had EXPOSURE to S. Neurona, a causative agent of EPM. Serum tilters range from <1:250 (negative) to >1:4000 (high positive). S. Neurona (SarcoFluor) is one of two protozoa found in EPM infected horses, the other protazoa is N. Hughesil (NeoFluor). S. Neurona is most frequently seen, whereas N. Hughesil is not as common.
The vet ran another EPM test to confirm the findings in the 8/30/16 test. The results showed that Chance had “Combined SAG 2,3,4 Tilter on serum= 1:1000. Again, Chance showed EPM protozoa in the positive-ish range.
I initially had not seen the results but was told by the vet that he was EPM negative. So when I asked for the test results to be emailed to me and saw the numbers I sort of freaked out…I emailed the vet to ask for clarification. She explained,
“The EPM test shows that he was exposed to the organism in the first test we did which is why we did a follow-up test. Since his exposure level dropped from 1:2000 to 1:1000 this shows that he does not have the disease. There is no good one time test for EPM once they are exposed which is why we had to do the repeat to compare the two.”
While this explanation offered me comfort, I was confused…why does he have any protozoa in his blood if he doesn’t have EPM?
I spoke to another vet and she explained it in a bit more detail…I am hoping I am summarizing what she said correctly..
When a horse tests positive for EPM they either have an active disease or they may not. However, when the test does from 1:2000 down to 1:1000 this typically means that the horse’s immune system is working correctly to fight the disease off- active or not. EPM testing typically provides you with a % of the chance your horse has an active EPM infection, or at least if you send it to Cornell University. For instance, lets say a horse gets the results back and it shows that they are “positive” or have been exposed to S. Neurona (one of the two EPM protozoa)…their results are 1:647. This means that, after doing a bunch of adding and multiplying that this vet kindly did for me, the horse has a 60-70% chance of having ACTIVE EPM. Meaning, he most likely would be symptomatic (ie: behavioral changes, ataxia, weight loss, difficulty eating, changes in soundness, and a bunch of other neurological symptoms).
My hunch is that Chance’s immune system was boosted because I started him on Transfer Factor (amazing stuff… more information can be found in some of my older posts) again as soon as his results came back positive for Lyme.
Resources on how to diagnose, treat, prevent, and handle lameness in horses
Common Causes of Lameness in the Fetlock
Past Treatments Tried
Chance showed decreased movement in his right hip and a audible cracking noise at the suspensory joint. He has edema of both hind fetlocks, Pastern, and Pastern Dermatitis. Chance was unshawed on both hinds due to his inability to stand for long periods of time and his decreased mobility. However, his front adorned clips.
Due to the length of Chance’s front toes and the height of his heels he was unable to evenly distribute his weight (60/40) to his front and hind ends. This would most likely cause increased tension on the DDFT tendons and corresponding ligaments resulting in an increased likelihood of tendon and ligament related injuries. The uneven distribution of weight could also inhibit the horse’s range of motion through his hips resulting in his body compensating for this injury and causing ataxia (balance issues), pain, arthritic changes, and cervical spine misalignment.
By shortening the toe of both front feet, the heel will rise allowing a more even distribution of his weight.
Final Product: Front
Trimmed feet to corrected to the following specifications:
Foot Beginning Angle & Toe Corrected Angles & Toe Total P.C.
L/F 47 Degrees at 3 7/8 inches 53 Degrees at 3 inches 6 Degrees
R/F 45 Degrees at 3 3/4 inches 54 Degrees at 3 inches 9 Degrees
Final Product: Hind
| Return visit to trim and shoe Chance’s hind feet with #2 OBRHB Wedge shoes.Trimmed hind feet and corrected to the following specifications:
Foot Beginning Angle & Toe Corrected Angles & Toe Total P.C.
L/H 48 Degrees at 3 7/8 inches 54 Degrees at 3 1/4 inches 6 Degrees
R/H 46 Degrees at 4 1/4 inches 55 Degrees at 3 1/4 inches 9 Degrees
Note: Chance needed to be sedated by veterinarian to complete the trim and shoe his hind feet due to preexisting hip and DDFT issues.
Judith M. Shoemaker, DVM 305 Nottingham Road Nottingham, PA 19362
717-529-0526 Fax 717-529-0776
Ozone therapy has been utilized and heavily studied for more than a century. Its effects are proven, consistent, safe and without side effects. Why is it not more universal in its use? Many of you have come with some trepidation about infusing a gas into a vessel because you are concerned about emboli, or have some dreadful fear about ozone’s toxicity since we frequently hear about the unhealthy ozone levels in the atmosphere. These fears do not apply to properly administered medical ozone, and the potential benefits of ozone therapy are profound and without associated detrimental effects.
Oxygen, in its several forms, cycles through the atmosphere and life processes just as water does. Ozone is produced in the upper atmosphere when UV light strikes the oxygen rising from plants, plankton, and algae in our forests and seas. It then falls back through the atmosphere, as it is heavier than air, combining with pollutants and water, cleaning the air and forming peroxides that benefit plants. Ultraviolet light breaking down pollutants and nitrous oxides also can produce ozone at the ground level, which is the eye and lung irritant in smog.
Medical ozone, used to disinfect and treat disease, has been around for over 150 years. Used to treat infections, wounds, and multiple diseases, ozone’s effectiveness has been well documented. Ozone has been used to disinfect drinking water since before the turn of the last century. A text on medical ozone therapy was published by Dr. Charles J. Kenworth in 1885! The best technology for producing ozone gas was designed and built by Nikola Tesla in the 1920’s. Heads of leading medical institutions in the U.S. contributed to a 1929 book “Ozone and Its Therapeutic Actions” describing the treatment of 114 diseases using ozone.
In 1933, the AMA began its systematic suppression of all modalities of treatment that did not complement its liaison with the emerging pharmacologic and diagnostic industries. Ozone therapy, along with many other useful therapies, were methodically eliminated from the educational process and exposure to the public in the U.S.
Less suppression has occurred in Europe and other countries, especially in Russia. Today in Germany, and other countries, ozone therapy is commonplace. Over 7000 doctors in Germany use it daily. In fact, in Germany, ozone generators are in ambulances for treatment of stroke victims. The incidence of permanent paralysis in these patients is much less than that in similar patients where ozone is not used.
Ozone generators are relatively simple and inexpensive. The equipment used to handle ozone is readily available but needs to be relatively non-reactive. Glass, Teflon, Kynar, silicon, and gold are completely non-reactive. Equipment made of other substances can contaminate the ozone or just deteriorate rapidly using up the ozone and becoming nonfunctional.
Generators use several technologies to produce ozone
Ozone poteniates free radical scavenging substances and systems in the body, inducing the production of superoxide dismutase, catalase, and glutathione peroxidase. If ozone administration causes any respiratory irritation from out-gassing through the lungs, a bolus dose of 1 to 5 grams of vitamin C can be given and will eliminate any coughing instantly.
Oxygen/ozone mixtures cannot cause emboli when injected at reasonable rates as they dissolve and diffuse very quickly in body fluids, unlike air (predominantly nitrogen) which is what forms emboli and causes the bends or decompression disease.
The physiologic actions of ozone are many, the simplest of which is to provide sufficient oxygen to allow complete oxidation of sugars and other fuels to produce sufficient and efficient energy and to “burn clean” to CO2, water, and inert end products. If not enough oxygen is available, then incomplete oxidation occurs, producing carbon monoxide, lactic acid, and partially oxidized toxins that inhibit further oxygen metabolism and “clog the system”, tying up hemoglobin, water, and the mechanisms for function and elimination.
Administration can be through any route with modifications:
Antioxidants help the body to protect itself from excessive oxidative damage caused by multiple free radicals, many of which are inactivated by ozone. The support of free radical scavenging systems is important but only oxygen can improve the deficit that makes cells vulnerable to oxidative damage in the first place. Long-term ozone therapy can be augmented by supplementation with antioxidants, but normally they should not be administered within 4 to 12 hours of ozone therapies.
Ozone produces the same effects as exercise, which produces significantly more free radical oxygen than can be administered in any ozone treatment. Ozone equals ”exercise in a syringe” without doing joint damage.
Ozone potentiates more complete oxidation, helps to maintain more normal body temperature and increases the effects of most hormones, vitamins, herbs, homeopathics, and drugs. Concurrent ozone administration reduces the amount of chemotherapeutic drugs needed to achieve effect by 1⁄4 to 3⁄4. It complements chelation therapies and frequently improves the affect and sense of well being in patients.
Continued therapy will allow Herring’s Law to manifest “Healing from inside to outside, top to bottom, front to rear, and in reverse chronological order of the insults to the body.” Healing crises, however, may occur. Ozone therapy facilitates the rapid resolution of these crises.
2005 Judith M. Shoemaker, DVM