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/
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
A little over a year ago Chance was diagnosed and treated for a lesion on the Deep Digital Flexor Tendon (DDFT) of his hind fetlock. At the time, I decided to go with Stem Cell injections due to it being the least invasive treatment option. The Stem Cells worked wonders and Chance went from barely being able to walk to running up hills, from daily pain medications to a supplement (DuraLactin) to help with pain and inflammation) for arthritis.
A few months ago I wanted to see how Chance’s fetlock was holding up. He did not have any symptoms- no swelling, lameness, etc- but I wanted to make sure. The ultrasound revealed that he did still have a small lesion on his DDFT that the vet felt was “congenital” and not problematic. But due to his history I wanted to ensure that it stayed non-problematic. I invested in some protective and supportive hind boots for hi to wear when he is outside or stall bound due to weather and decided to do a round (about 5 sessions) of laser treatments on his hind leg. The laser treatments are relatively inexpensive (about $65.00), non-invasive, and pretty much risk free.
We are coming up on our 3rd treatment and due to Chance being asymptomatic it is hard to tell if they are beneficial until we do another ultrasound. Once an ultrasound is completed I will post more.
Article on Stem Cell Treatments: http://www.rossdales.com/news/new-stem-cell-trial-to-treat-deep-digital-flexor-tendon-injury.htm
Articles on Laser Treatments: Research Laser Therapy
The other day I noticed that Chance’s back fetlock a were slightly swollen and he was visably stiffer then normal. I also noticed a golf ball sized lump in the middle of the his chest. It wasn’t super sensitive and looked like a tick bite reaction, except there was no tick and a tiny barely noticeable scratch.
I put a Poltace wrap on his back right leg (which was the leg he had previously injured and received stem cell injections in) and gave him some pain medication. I also started him on Baytril and Ulcerguard as a precaution as previously advised by the vet.
I made an appointment with our vet to come ultrasound his hind right leg and she was to come out in the next two days. I was incredibly anxious to say the least.
The vet arrived and explained that the lump on Chance’s chest was a hematoma from another horse biting him or from him hitting something. Nothing to worry about, it was just the pooling of fluids to lowest point.
I then trotted Chance back and forth as the vet watched. After an exam and the ultrasound, the vet explained that she felt that the swelling was due to Chance’s hip pain and the Pastern dermatitis that we have been treating and we’re finally coming off.
The ultrasound showed a tiny DDFT lesion (vet referred to as a defect that shouldn’t be causing any symptoms). The ultrasound also showed scar tissue that we need to get “stretched out” so that he can gain increased flexibility and work as a protection for Chance’s tendons and legiments. The ultrasound also showed some fluid build up as well. Chance’s Fetlock looks good as do his legiments.
The vet wants Chance to stay on Baytril and Ulcerguard until complete. She also has added a 5 day course of Benadryl and steroids to help with edema of back hind legs.
She also provided me with a shampoo that is milder to clean off scratches and apply swat after cleaning. The vet explained that she didn’t understand why people picked the scabs from the scratches because they’re super deep and pulling the scabs off does more harm than good.
The Vet commented on Chance’s weight gain and how great his skin looks gooded. She wants me to continue working on the scratches and continue doing physical therapy on hills to build up his hind end then get farrier out for back feet.
All and all I feel good about how Chance is doing and feeling. He is still full of energy, eats like he hasn’t eaten in a week, and his eyes and coat are bright. He is not on daily pain medication and is only given it when he is not feeling great. Aside from a few hiccups, Chance is loving life and being spoiled!
Chance is continuing to gain weight, although as I said in the previous post, he still needs to put on a good 50-75 lbs. As the days continue to get warmer, Chance’s arthritis seems to become more manageable for him; his stride is longer and he runs around (mostly after Lucky) more frequently.
Unfortunately, when the farrier came out about two weeks ago Chance was too stiff to get his back right shoe on. The farrier decided to come back out to try and re-shoe him and, during that time in between, Chance must have tweaked it…AGAIN!
While Chance did not have a shoe on his back right I kept it wrapped to provide some protection and also even out all of his hooves. However, when I arrived I noticed that Chance was significantly twisting his back right leg inward at the walk & it had some swelling. The swelling was not horrible but it was noticeable. I cold hosed his leg for about 45 minutes while I groomed him & gave him a dose of Equinox (pain medication) and Ulcer Guard. I put on his back leg wrap to help with reducing the swelling and provide some extra support. Chance did his neck stretches effortlessly and was baring weight on his back hind.
But as I was grooming him I noticed, on the left side his chest, he had patches of hair loss and dandruff. The area did not look red or inflamed, nor did it seem itchy or painful. So I continued grooming him and decided to put a call into the vet to come and check his leg and the hair loss.
Of course, I turned to Google to try and find out what exactly could be the cause of the patches of hair loss.
According to a handful of sources, there are a few possibilities for hair loss- mites or Lice, a vitamin deficiency, rain rot or crud, or even just his natural shedding tendency. A skin scrape would help to confirm what may be the cause.
As for the swelling of Chance’s back right leg, I decided to call our previous vet who collected and injected Chance’s DDFT with stem cells to heal the hole in his tendon. We have some stem cells left over and I wanted to see if injecting his leg again would be of any benefit. I also would like to get an ultrasound recheck to ensure that there is not another injury to his DDFT tendon sheath again.
The twisting of his back hind leg is worrisome as well.
Everything I have read about EPM states that horses can have a relapse in symptoms after treatment is complete. My concern is that the twisting are due to the neurological symptoms coming back since Chance’s EPM treatment has been finished for a little over two weeks….
Our current vet believes that Chance’s ataxia and twisting is not due to EPM but his cervical spine instead. Could the twisting be worse due to the swelling of his hind leg? Or is the swelling and the twisting two separate issues all together?
Text from Vet4 after ultra sound #3:
“I can see that he has a deep digital flexor tendon lesion and the medial side of the tendon sheath has improve but lateral side is about the same. The DDFT may the cause of all this in the first place and everything else is secondary. We will re ultrasound in 10 days or so just to confirm my findings. If they are correct, it would help to treat that area.”
Conversation with Vet4 :
So far, Chance has received; shock wave therapy, compression therapy and laser therapy.
Chance has a hole in his tendon. Vet4 believes that this is due to an infection/bowed tendon and severe lameness. The ultrasound, done yesterday, shows no change in size of the tendon hole after the previous two rounds of injections.
“Lymphangitis is a symptom rather than a cause and the cause was never treated.” Vet1 continued to treat it like a disorder rather than a symptom!
The swelling and infection have dissipated, as has the severity of the lameness. Though still lame, he is running around in the pasture.
Pain meds were started again due to increased discomfort and soreness.
Vet4 suggests doing one of the following:
1. Stem cell- which can take about two days if sample drawn has enough stem cells. If not, it could take about 4-6 wks to culture. Once injected he can move home. He is to be hand walked for a few days and then can go out as normal. Vet4 will come out in about a month to do another ultrasound and, depending on the size of the hole, may need to do further injections.
2. Surgery to clean out but NOT repair the tendon. This was not discussed in detail.
Payment plans may be an option. I emailed the office for payment options.
Time to make another decision!
When I arrived at the farm I was greeted by those familiar big brown eyes and a whinny.
I brought him out of his stall and gave him a bath. He has always loved to be groomed and bathed, even if he is apprehensive to walk into the wash stall. After his bath, we went outside for him to graze and get some sunshine. When we walked inside the barn, I stopped him and looked into his eyes and asked him, “do you want to keep trying to get better or are you ready to give up?” He just looked at me. A lump immediately formed in my throat. He nuzzled me and rubbed against me. I said again, “Do you want to keep fighting?” He shook his head up and down! I swear to you! This actually happened!
The decision was made, we would keep on fighting as long as we were able to keep him comfortable. There was nothing I wanted more than to bring him home with me, let him live out the last days of his life pain-free, and with me by his side.
This was his turn. He had always done what I asked of him- lessons, moving stables and even cities, and he was patient while I was in school- and it was his turn for me to make it about him. For Chance to get every ounce of my time and for me to fight for him!
The first round of injections provided Chance with some relief, in his ability to move around and the swelling went down a bit, but that only lasted about a week. At about day 8, Chance was swollen again and 3 legged lame. Thankfully, a family friend of the farms owner called me. She explained that the farrier was out shoeing one of the horses and saw Chance’s leg, and when he arrived to shoe her horses, he expressed his concern. I immediately contacted Vet4 an he was out the following day.
Vet4 injected the masses again as a temporary fix, until we could make some decisions. The ultrasound showed that the masses were the exact same as they were in the first ultrasound- they hadn’t increased or decreased in size.
Later that evening, Vet4 and I had a lengthy conversation about where to go from here.
We discussed the options again, at length. We could do an MRI to gain more insight into what is happening with that leg, go in with an Arthroscope and clean it out, or look into Stem Cell Therapy.
Well, I wasn’t comfortable putting Chance under anesthesia…he was too old and too frail. Plus, he could break a leg or a hip going down. So, that ruled out the MRI (unless I could find a standing one) and the surgery. The Stem Cells would run about $3000.00, plus he would need to goto the hospital to have the procedure done.
I took the night to think it over, and stayed up until sunrise reading as much as I could on leg issues, the different options vet4 and I had discussed, and other potential causes.
That next morning, I received a call that Chance was worse. Vet4 was out of town due to an emergency, so I called Vet3. She got out to the farm immediately.
Vet3 gave Chance Surpass topical to put on the leg, Banamine, Ulcer Guard, and continued with the Prevacox to keep him comfortable.
I asked her what she thought about the options- she felt, as I did, the surgery wasn’t a good idea and that an MRI should only be done without sedation.
I called Vet4 and we spoke about the current situation. What else is going on? He suggested changing the course and trying different diagnostics. He explained that TSMs (Tendon Sheath Masses) can cause swelling and pain, but they are usually relieved by the injections. The ultrasounds showed that his suspensory tendon and ligaments looked good. Could this be an infection? Soft tissue damage? A bone issue?
I asked him if he felt moving forward with more tests was a bad thing…was I being cruel keeping Chance alive like this? Something that had been weighing on me from the start. And what Vet4 said, empowered me to continue down the path I initially felt in my gut to be the right decision. He said, “I am not the kind of person to ever give up on someone or something.” I asked if we were able to manage his pain adequately and make sure he was comfortable and he said, yes. He advised me to “make a decision based on the horse” and “not to listen to the opinions of everyone else”.
The next day, I cleared my schedule, and headed to the farm.
Chance was able to come home a week later. Sam & John went to pick him up at the hospital. However, upon arriving, they soon found out that Chance did not want to get on the trailer. Sam later told me that one of my sweatshirts was in the truck, so she brought it out and let him smell it- he finally loaded.
I got his stall ready- tons of fresh shavings, hay, a new water bucket…
The moment he got off of the trailer he was shaking! I gave him a warm bath and let him out in a small, flat paddock so he could be in the sunshine.
This is what happened when I let him out! He did something he had not been capable of doing for months and months, if not longer.
Vet4 came out immediately. I was beyond grateful!
He did an ultrasound of the back right leg and called me. He found that Chance has Chronic Cellulitis and that there was Vascular constriction, and masses on the tendon sheath between the superficial and deep tendon sheaths. The Doppler showed good blood flow and a thickening of the synovial lining. Hoof testers- Negative
We spoke about my opinions- MRI, Arthroscopic surgery, Regional Diffusion, Cold Compression Therapy, Nerve Block Injections, Steroid Injections
We decided to try the Steroid Injections into the 3 Synovial masses to hopefully reduce the size and thickening. Thus allowing us to see behind the masses to see what is actually happening.
Injections were into the Proximal Digital Flexor Tendon Sheath with 6mg Betamethasone and d100mg of Amikacon. Leg was covered with SSD and DMSO and bandaged.
Once injected, cold compression therapy for about 5 days twice a day and stall rest. Banamine daily.
The month passed by slowly….I kept hitting a brick wall over and over again…with each diagnostic test we ran.
Vet2: This was Chance’s vet for many years and where Chance lived the summer I moved home. Vet1 was used because of connivence and due to being the vet of the owner of the farm. I called Vet2, desperate, and she came out to see him. Vet2 had always been amazing with Chance- kind, calm, and seems to act on intuition in conjunction with science. She ran a CBC, tested for Cushings, Lymes, an did x-rays on the back right leg.
* Metabolic Syndrome- Cornell
ACTH endo 21.4 pg/ml
INSULIN 15.22 uIU/ml
THYROXINE T4 baseline 0.77 ug/dl
*Lyme Mitpix- Cornel
OspA Value 1253- Equivocal
OspC Value 79- Negative
OspF Value 592- Negative
Temp: 99.1, HR: 42, RR: 12, No murmur
Received Potomac Rabies and Stanozanol 4ml 7 vit B12
The X-rays of his back right showed nothing that could cause his flare-ups. While his thyroid was a bit low, it was not clinically significant. He was negative for Lymes and Cushings. Next step, aside from pain management, is to call Vet3- the holistic approach.
One day I received a call that I needed to come out and see Chance because he wasn’t doing well and, according to Vet1, he needed to be put down. I quickly canceled my appointments and got on the road. The 4 hour drive was excruciating…once we finally arrived, my heart broke.
My old guy was skin and bones. His back right leg was swollen and he wasn’t able to bare weight on it. His eyes were dull. He could barely walk, and when he did, he wouldn’t put any weight on the right hind. There were even times when he would do this “neurologic dance” (coined by the farm’s owner and C’s other mom) where he would lift up his back right leg and hop!
But when he saw me pull up, he whinnied. He was excited to see me. He ate the pureed carrots but refused the apple puree (only my mom would make this for him). He wasn’t ready to die.
I called the vet who said that Chance should be put down to see what his thoughts were.
Me: What do you think is going on with C?
Vet1: I think he is ready to be put down.
Me: Because of what?
Me: Okay, well, what is the cause of the Lymphangitis? Did you run any diagnostics?
Me: I would like to manage his pain and run a few tests before making that decision. (I reviewed the research that I had done and asked where to go from there.) Could it be EPM?
Vet1: “It’s not EPM”
Me: How about Cushings? Or Laminitis? Lymes?
Vet1: Nope. Just old age.
Me: The journals I read said that some of the symptoms…(I was cut off)
Vet1: “I don’t care what journals you read! It’s a bunch of…”
Me: One was from VA Tech actually…
Well, that was that! Vet1 did not completely lack compassion but he was more “old school” I guess one could say. He was well respected in the horse world and up until this point, he did the job I needed. But I will say I was disheartened by our conversation.
I decided to contact the other vets that I had worked with in the past, who also knew Chance, and get second, third, fourth opinions.