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Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17239
Registered: 1-1997
| | Posted on Monday, Dec 11, 2006 - 12:05 pm: |   |
Currently there are two chemical methods described to fuse joints: ethyl alcohol and sodium monoiodoacetate. The sodium monoiodoacetate is the older and better described method. The chief disadvantage being it is a percentage of horses become very painful following the procedure. Intra-articular administration of ethyl alcohol is currently an experimental procedure that shows great promise for arthrodesis of the joints of the hock. Horses have minimal to no lameness associated with the treatments.
Am J Vet Res. 2006 May;67(5):850-7.
Use of intra-articular administration of ethyl alcohol for arthrodesis of the tarsometatarsal joint in healthy horses.
Shoemaker RW, Allen AL, Richardson CE, Wilson DG.
Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada.
OBJECTIVE: To evaluate the efficacy and safety of intra-articular administration of ethyl alcohol for arthrodesis of tarsometatarsal joints in horses. ANIMALS: 8 healthy female horses without lameness or radiographic evidence of tarsal joint osteoarthritis. PROCEDURE: In each horse, 1 tarsometatarsal joint was treated with 4 mL of 70% ethyl alcohol and the opposite joint was treated with 4 mL of 95% ethyl alcohol. Lameness examinations were performed daily for 2 weeks, followed by monthly evaluations for the duration of the 12-month study. Radiographic evaluations of both tarsi were performed 1 month after injection and every 3 months thereafter. Gross and histologic examinations of the tarsi were undertaken at completion of the study. RESULTS: Horses had minimal to no lameness associated with the treatments. Radiography revealed that 8 of 16 joints were fused by 4 months after treatment, with significantly more joints fused in the 70% ethyl alcohol group. Fifteen of 16 joints were considered fused at postmortem examination at 12 months. Gross and histologic examinations revealed foci of dense mature osteonal bone spanning the joint spaces. Bony fusion appeared to be concentrated on the dorsolateral, centrolateral, and plantarolateral aspects of the joints. Significant differences were not detected between treatment groups for lameness or pathologic findings. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of ethyl alcohol into the tarsometatarsal joint of healthy horses appeared to facilitate arthrodesis of the joint in a pain-free manner. Results warrant further investigation into the potential use of ethyl alcohol in horses clinically affected with osteoarthritis of the tarsometatarsal and distal intertarsal joints. |
Mary Rutherford
Member
Username: Caymie
Post Number: 239
Registered: 10-2002
| | Posted on Wednesday, Dec 13, 2006 - 7:23 pm: | |
Hi Dr. O.,
If you were going to try and facilitate fusion of a hock, would you try this method prior to resorting to surgery?
Mary |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17258
Registered: 1-1997
| | Posted on Thursday, Dec 14, 2006 - 6:26 am: | |
For arthritis of the distal 2 joints of the hock I believe I would Mary, the procedure was favorably reviewed at the recent AAEP.
DrO |
Mary Rutherford
Member
Username: Caymie
Post Number: 240
Registered: 10-2002
| | Posted on Thursday, Dec 14, 2006 - 9:03 am: | |
Dr. O.,
That's really interesting, can you tell me more about what was said at the convention? Can you continue to ride the horse while he is undergoing treatment? Can he have bute and/or intraarticular injections while the fusing process is going on?
Does this actually work?
We are in the process of trying to decide what to do about my horse. He has arthritis in the two distal hock joints of his right hock, but not the one that communicates with the upper hock joint. The injections aren't even lasting him three months. He is a very big warmblood with a low tolerance for pain. The rest of him is in super shape! So, we are going to block him out again. If he blocks out to the lower hock joint, then I have to decide what to do re: surgery vs. this new treatment. My surgeon is suggesting trying the alcohol first, as he says we could always do the surgery if it doesn't work.
Mary |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17261
Registered: 1-1997
| | Posted on Thursday, Dec 14, 2006 - 6:51 pm: | |
They said less than is in the summary above Mary, just that it looked promising.
Addressing your questions: I have not seen any work that says riding is good or bad, but in an effort to keep the alcohol from diffusing to surround areas my thoughts would be to turn the horse out to pasture while fusion occurs and avoid forced work. I would avoid bute unless the discomfort is remarkable. Why would you want to do injections after the procedure?
Does it work? The initial experimental work is very encouraging, but we don't have any field cases to draw real like examples from.
DrO |
Mary Rutherford
Member
Username: Caymie
Post Number: 241
Registered: 10-2002
| | Posted on Thursday, Dec 14, 2006 - 7:41 pm: | |
Dr. O.,
I didn't know how much discomfort there might be, hence my questions about using injections while the fusion takes place, if I were to continue riding him.
The vet is going to block him out tomorrow. If it is the lower hock joints, then we will make a decision re: treatment. If not, then I guess I don't have to worry about it at the moment.
Thanks for the info.
Mary |
Mary Rutherford
Member
Username: Caymie
Post Number: 242
Registered: 10-2002
| | Posted on Tuesday, Jan 2, 2007 - 9:55 pm: | |
Hi Dr. O.,
Is a contrast study with radiography an accurate test to determine whether there is communication between the lower hock joints and/or the upper hock joints?
Thanks,
Mary |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17381
Registered: 1-1997
| | Posted on Wednesday, Jan 3, 2007 - 8:13 am: | |
Contrast studies can show the communication Mary but I have never seen an experiment designed to see if it is 100% accurate.
DrO |
Mary Rutherford
Member
Username: Caymie
Post Number: 243
Registered: 10-2002
| | Posted on Wednesday, Jan 3, 2007 - 10:33 pm: | |
Hi Dr. O.,
Well, stay tuned, for Caymann has just joined the ranks of the great ethyl alchohol experiment. They blocked out his tarsometatarsal joint (for the hundredth time over the past year)today, and it again resolved his lameness, which has definitely worsened throughout the year, and markedly so the past couple of months. Our hunch is that the cartilage is continuing to wear away, since his radiographs don't match the level of pain he is in. He has been battling this for almost four years. The hock injections only last about six weeks, and even then he has never been completely sound. My vet recommended trying this over surgery, and said you can always go back and surgically fuse the joint if this doesn't work. I can start riding him in a month. Do you know of anyone who is trying this with their horse?
Mary |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17394
Registered: 1-1997
| | Posted on Thursday, Jan 4, 2007 - 7:16 am: | |
Mary, you are the first personal contact and I will be interested to watch this play out but don't worry too much the initial work on this looks very good: high success with no complications.
DrO |
Fran C
Member
Username: Canter
Post Number: 798
Registered: 1-2000
| | Posted on Thursday, Jan 4, 2007 - 8:07 am: | |
Oh, Mary! Can't tell you how sorry I am to hear of Caymann's continued troubles. As always, I'm keeping my fingers crossed for a good outcome for you. |
Mary Rutherford
Member
Username: Caymie
Post Number: 244
Registered: 10-2002
| | Posted on Thursday, Jan 4, 2007 - 9:24 am: | |
Hi Dr. O.,
Thanks so much for the encouraging words! I trust my very wonderful veterinarian (Dr. Gary Baxter of Colorado State University)implicity. He has been our guide through this past year, which has been a challenging one as you know from our posts. He felt that this was the best option for Caymann, as it provides him with the best chance for fusion, with very little pain. He has been in enough pain for way too long. The best part for me is that I can continue riding him and he can have bute if needed. However, he may not need it. Since we now believe that the cartilage in that joint is eroding even further, we are just helping him along with the process. This explains alot of what has been going on this past year and why we have never really been able to get him sound even with the injections. I am so relieved that we may have another option besides surgery. I will definitely keep you posted throughout this process.
Mary |
Mary Rutherford
Member
Username: Caymie
Post Number: 245
Registered: 10-2002
| | Posted on Thursday, Jan 4, 2007 - 9:32 am: | |
Hi Fran,
Maybe this will sound strange to you, but I am more relieved than sad. For me, the relief in finally knowing definitively that the source of his pain the past four years has been his hock. I would have been very surprised yesterday if he hadn't blocked out to that joint. It's funny how four years can come down to one simple little block. I am so thankful that he chose to have this problem in a joint that we could fuse. If this were any other high motion joint, he would be done. The rest of him is in fabulous shape, if this fusion is successful, he has a long career ahead of him. I am also grateful that this other option has come along in time for him. Mostly, I feel relief for my beloved horse who has been through so much. Nothing will give me greater joy than to know he is no longer in pain, and that we will hopefully achieve that goal in the most humane way possible.
I do appreciate your support and kind words. We'll keep you posted and you keep riding that beautiful Holsteiner girl of yours. Caymann can't wait to send her a picture of his pain free hock!
Mary |
Zoe Williams
Member
Username: Fahren
Post Number: 17
Registered: 11-2006
| | Posted on Monday, Jan 8, 2007 - 11:09 am: | |
Dr. O,
Is there an age that this treatment would be inadvisable. I have a coming two year old and a four year old that both need to fuse, but is it a problem that they are both still growing (large warmbloods).
Mary,
I hope you dont mind me asking the ballpark of cost for this procedure in your area?
Thanks!
Zoe |
Mary Rutherford
Member
Username: Caymie
Post Number: 247
Registered: 10-2002
| | Posted on Monday, Jan 8, 2007 - 11:17 am: | |
Hi Zoe,
I don't mind at all and the funny thing is that all of the diagnostics we have done over the past year have cost way more than one intra-articular injection of ethyl alcohol!! The actual injection itself probably cost less than a hundred dollars. They did some radiographs which were around $150.00. Then there was the lameness exam fee as well as a large animal professional fee charged by the hospital. Our entire day cost somewhere between five and six hundred dollars. That also included the blocking out of the hock joint and some sedation because you have to sedate him to block him as he is tired of being poked with needles! But the actual injection itself is very inexpensive.
Mary |
Zoe Williams
Member
Username: Fahren
Post Number: 18
Registered: 11-2006
| | Posted on Monday, Jan 8, 2007 - 12:12 pm: | |
Thanks Mary!
I know I have spent thousands on diagnostics and checking progression! That sounds well worth it!
Zoe |
Mary Rutherford
Member
Username: Caymie
Post Number: 248
Registered: 10-2002
| | Posted on Monday, Jan 8, 2007 - 12:36 pm: | |
Hi Zoe,
It will be well worth it if Caymann's hock successfully fuses! If this treatment works-it will be priceless to me. No surgery, minimal pain for my horse, I can ride him through the fusing process, and I can continue on with my beloved horse!
Mary |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17450
Registered: 1-1997
| | Posted on Monday, Jan 8, 2007 - 7:10 pm: | |
Not that I am aware of Zoe and it would be hard to imagine what that would be, but the treatment is still in its infancy.
DrO |
Zoe Williams
Member
Username: Fahren
Post Number: 19
Registered: 11-2006
| | Posted on Monday, Jan 15, 2007 - 9:21 am: | |
Hi Dr.O
I had requested this procedure from my vet starting with my 4 y/o. His receptionist finally got back to me saying he did not want to do it because he thought it to risky. Something about melting joints. I asked her to elaborate and she said he would give me a call. He is a well respected vet and runs the referral surgery center in our area. But maybe there was a miscommunication in what I wanted, though I was pretty clear. What "dangers" could he be talking about. I know anytime you inject a joint there is risk of infection. But isn't that the same with steroids which he is happy to do?
Zoe |
Zoe Williams
Member
Username: Fahren
Post Number: 20
Registered: 11-2006
| | Posted on Monday, Jan 15, 2007 - 4:25 pm: | |
Dr.O,
My vet just got back to me with this info:
Zoe,
Thank you for your email. Hope you are doing well and that you had a great holiday season.
My reluctance to perform the injections at this time is based on the following:
- The sodium monoiodoacetate injections causes a level of pain that is pretty much inhumane for the horses. And people have lost horses due to this procedure.
- The abstract of the article you sent shows promise about the future of the alcohol treatment. It's an pilot study that has not reported in detail the long term prognosis of these horses.
- The authors write the following message at the end of the study: "Results warrant further investigation into the potential use of ethyl alcohol in horses clinically affected with osteoarthritis of the tarsometatarsal and distal intertarsal joints.
- I cannot at this time try and use an experimental treatment which carries potentially serious side effects. The sodium injection studies have shown that several horses have joint fluid communication between the tarso crural joint and the proximal intertarsal joint, which would lead to severe arthritis of the main hock joint.
Also, in the recent AAEP (American Association of Equine Practitioners) there was an open forum discussion about the alcohol treatment option and it was decided at the time this was not a viable option treatment based on the level of pain and complications associated with the procedure.
Other options at this time would be injection with a strong dose of steroids, or fusion of the joint space using orthopedic removal of cartilage from he joint using a drill technique.
I hope you understand where I am coming from. Loosing a horse like Calypso based on an experimental try has strong implications for my practice.
Let me know if you have any more questions about this.
I just wanted to get you opinion.
Zoe |
Mary Rutherford
Member
Username: Caymie
Post Number: 250
Registered: 10-2002
| | Posted on Monday, Jan 15, 2007 - 11:35 pm: | |
Hi Zoe,
I will defer to Dr. O on this one, but wanted to comment on my personal experiences. I am not trying to persuade you one way or the other. We each have to make the decision we feel is best for our horse.
I was not aware that anyone even uses the MA treatment anymore due to intense pain that some horses experience, and the disasterous consequences if the MA were to diffuse outside of the intended joint.
I am very well aware that this is still considered an experimental treatment. I very carefully weighed the risk of trying this vs. putting my beloved horse under general anesthesia again, which in my mind was almost as risky. The only potentially serious side effect that I am aware of is the possibility that the alcohol could diffuse to the proximal intertarsal and tarsocrural joint. That would be very bad. That was the reason that my vet was only willing to inject the tarsometatarsal joint. We did not separately inject the DIT joint, because he blocked out so soundly to just the tarsometatarsal joint, and because of the chance it could diffuse to the higher motion hock joints. However, there is the possibility of some diffusion from the tarsometatarsal joint to the DIT joint. (and if it does and fuses that joint too, I will consider it a bonus!)He felt it was very unlikely that it would diffuse from the tarsometatarsal joint to the proximal intertarsal joint/tarsocrural joint. I do not know that I would feel comfortable injecting the DIT joint directly even with the contrast arthrogram.
All indications are that this is not a painful procedure at all, that is why if this works consistently, it is such a great method. I can tell you right now that since my horse has been injected with the alcohol almost two weeks ago, he is less painful than he was prior to the injection. They will evaluate him in another two weeks, and will take some more radiographs.
The cost of the surgery was not the issue for me. If this works, we will have facilitated the fusion of the joint in the most humane, non-invasive, and pain-free manner to my horse possible, without the risks associated with surgery. If it does not work as expected, we can always go back and do the surgery. The plus for me is that I can start riding him shortly while the fusion process is going on. I, along with my vet whose opinion I trust, made the decision that we felt was best for my horse. There can be no question that we are going out on a limb here to some extent. But to me, the cons were far outweighed by the pros.
Losing my beloved horse has strong implications for my mental health. I did not make this decision lightly.
Mary |
Mary Rutherford
Member
Username: Caymie
Post Number: 251
Registered: 10-2002
| | Posted on Monday, Jan 15, 2007 - 11:42 pm: | |
Hi Dr. O.,
OK, now Zoe has me thinking about this. Do you think it is unlikely that the alcohol would diffuse from the tarsometatarsal joint to the proximal intertarsal and/or tarsocrural joint?
Mary
P.S. Love the new design of the website! |
Zoe Williams
Member
Username: Fahren
Post Number: 21
Registered: 11-2006
| | Posted on Tuesday, Jan 16, 2007 - 8:19 am: | |
Hi Mary,
I was in the same boat as you. I had called my vet asking him to do this procedure...he said no and wrote the email above... It sounded like a great way to go and I hope it works out great for you. I am a bit stuck as I dont know that I would trust another vet i my area to do this procedure. My horse is one of those if it can go wrong it will... Curious to hear Dr. O's thoughts.
Zoe |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17515
Registered: 1-1997
| | Posted on Tuesday, Jan 16, 2007 - 8:42 am: | |
Zoe's vets points are all valid and have already been discussed above. In the tests done so far no one has described this problem but there are a percentage of horses who's upper and lower joints communicate. It is the reason for the advice on checking joint communication before doing the procedure.
DrO |
Mary Rutherford
Member
Username: Caymie
Post Number: 252
Registered: 10-2002
| | Posted on Tuesday, Jan 16, 2007 - 8:53 am: | |
Hi Zoe,
I forgot to mention that I did inquire about doing the contrast arthrogram prior to injecting the tarsometatarsal joint. My vet did not feel as though that was necessary for whatever reason. I don't exactly remember, but I thought he said something about it not being a completely accurate way to ensure there would be no diffusion.I certainly would insist on it if we were to go back and inject the DIT joint as well.
But as I mentioned above, I don't know that either myself or my vet would be comfortable doing that because of the possiblity of diffusion to the higher motion hock joint. My horse has never done things by the book either, so it does make me nervous!
I did call and talk to one of the vets who was heading up this experiment. As far as I know, none of the research horses had any diffusion from the lower hock joints to the upper. But that doesn't mean it couldn't happen.
For me, trying this method was the lesser of two evils. For someone else, the surgery may feel like the safer choice. I wish you all the best with your decision making process. Good luck.
Mary |
Lisa Zieman
New Member
Username: Lzieman
Post Number: 1
Registered: 12-2006
| | Posted on Thursday, Jan 18, 2007 - 10:25 pm: | |
Is there any chance of this working for a case of high ringbone? |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 17551
Registered: 1-1997
| | Posted on Friday, Jan 19, 2007 - 7:40 am: | |
Yes I think there is a chance Lisa, but there are some important differences. There may be a touch more natural movement here making arthrodesis without fixation less successful. Also it is technically difficult to accurately insert a needle in the proximal interdigital joint. I would wait until some research is generated on this location in particular before I would attempt it.
DrO |
Mary Rutherford
Member
Username: caymie
Post Number: 254
Registered: 10-2002
| | Posted on Monday, Jan 29, 2007 - 9:35 pm: | |
Hi Dr. O.,
Did they give any indication at the AAEP as to how long it might take after the initial injection of alcohol before some improvement is seen?
Thanks,
Mary |
Robert N. Oglesby DVM
Moderator
Username: dro
Post Number: 17654
Registered: 1-1997
| | Posted on Tuesday, Jan 30, 2007 - 6:33 am: | |
No the summary above gives the best indication I have seen.
DrO |
Fran C
Member
Username: canter
Post Number: 845
Registered: 1-2000
| | Posted on Tuesday, Jan 30, 2007 - 7:52 am: | |
Are you seeing no improvement, Mary? I keep hoping this is the ticket for Caymann.
Hugs from Sparkles. |
Mary Rutherford
Member
Username: caymie
Post Number: 255
Registered: 10-2002
| | Posted on Tuesday, Jan 30, 2007 - 8:54 am: | |
Hi Fran,
Today is his one month recheck at CSU. So I will let you know the results of his exam. Hooves crossed!
Mary |
Lisa Zieman
Member
Username: lzieman
Post Number: 17
Registered: 12-2006
| | Posted on Tuesday, Jan 30, 2007 - 10:18 am: | |
Good luck Mary. If you get a chance while speaking to your vet, will you pick his brain a little bit about how many of these he's done, and if he has ever attempted the procedure on the pastern joint? I live less than 90 minutes away from CSU, so I would definitely make the trek up north for that. Sorry to ask, I just hate to call the guy out of the blue and bother him if it's not something he does yet. Plus I'm sure some others would probably be interested in the kind of success he's had. Thanks! |
Mary Rutherford
Member
Username: caymie
Post Number: 256
Registered: 10-2002
| | Posted on Tuesday, Jan 30, 2007 - 11:08 am: | |
Hi Lisa,
I would be happy to inquire for you. Where in Colorado do you live?
Mary |
Lisa Zieman
Member
Username: lzieman
Post Number: 18
Registered: 12-2006
| | Posted on Tuesday, Jan 30, 2007 - 2:47 pm: | |
Thanks Mary. I grew up in Fort Collins, and went to CSU, but now I live about 10 miles SE of E-470 & Smoky Hill, so near SE Aurora. How about you? |
Mary Rutherford
Member
Username: caymie
Post Number: 257
Registered: 10-2002
| | Posted on Wednesday, Jan 31, 2007 - 8:12 am: | |
Hi Lisa,
We live in Wellington.
I have not forgotten about your question. I will inquire about it later today. My horse is going to have surgery today to arthrodese his right hock. Not only was there no improvement at his checkup, he actually looked worse. So, they blocked out his DIT and TMT joints separately. At least half of the pain is coming from the DIT joint, which does not really make him a candidate for the alcohol fusion as we do not want to directly inject that joint with alcohol because of it's close proximity to the high motion hock joint. Previously, they had just blocked his TMT joint only. There was probably some diffusion to the DIT joint, but there can be no denying the response to the blocks yesterday. Not all of the pain is coming from the TMT joint alone.
I will feel much better after the surgery is over, and will be happy to inquire about using the alcohol in the pastern.
Mary |
Zoe Williams
Member
Username: fahren
Post Number: 27
Registered: 11-2006
| | Posted on Wednesday, Jan 31, 2007 - 9:28 am: | |
HI Mary,
I am sorry to hear that the alcohol did not work for you. I was excited about the possibilities! Please keep us updated as to how the fusion goes. I will be very curious to hear as that seems to be the future option I have also. First hand experience will be very educational.
Good Luck.
Zoe |
Ann
Member
Username: dres
Post Number: 1141
Registered: 10-2000
| | Posted on Wednesday, Jan 31, 2007 - 9:51 am: | |
oh Mary, this is not what I was hoping to hear either.. What exactly are you doing in this surgery..???
On the first day God created horses, on the second day he painted them wth spots.. |
Lisa Zieman
Member
Username: lzieman
Post Number: 20
Registered: 12-2006
| | Posted on Wednesday, Jan 31, 2007 - 10:36 am: | |
Ditto Zoe and Ann. And in my case, as Dr. O said, the pastern joint is even tougher to do, so I'm not expecting Dr. Baxter to have any encouraging news on that front. Isn't it great to have one of the best vet schools in the country in your own backyard? Is it about $4000 for the surgery? |
Fran C
Member
Username: canter
Post Number: 849
Registered: 1-2000
| | Posted on Wednesday, Jan 31, 2007 - 1:15 pm: | |
That's disappointing to hear, Mary.... I'll be waiting to hear how Caymann comes out of the surgery.
Sparkles & I send our best wishes. |
Mary Rutherford
Member
Username: caymie
Post Number: 258
Registered: 10-2002
| | Posted on Wednesday, Jan 31, 2007 - 1:49 pm: | |
Hello all,
Thanks for your good wishes! Caymann is having his surgery as I type. To answer Ann's question, we are going to surgically fuse his right hock. Dr. Baxter will use the laser and drilling, as he has seen the best results with doing both. Zoe, I think the alcohol treatment still holds great promise. I was hoping it would work for us. However, once we determined that a large majority of the pain was coming from the DIT joint, he really no longer was a candidate for injecting alcohol into that joint. They are just not far along enough into using the alcohol to know whether injecting the DIT joint is a safe option. That scared me more than surgery because of the possibility of diffusion into the upper hock joint. And the horses in the experimental group were free of lameness at the time of injection, they did not have osteoarthritis/bone spavin in their joints.
Lisa, I think you are probably right, I don't think they have even attempted to fuse the pastern joint this way yet. CSU is just getting started with a study doing the hocks I learned yesterday. But I am going to ask for you, don't worry! And yes, we are fortunate to have CSU so close! Dr. Baxter has done a fabulous job with a case that has had more complications and bizarre happenings than one could imagine. I would recommend him to anyone.
Thanks for the good thoughts Fran. I will be very relieved once I know he has made it through the anesthesia recovery. We'll keep you posted.
Mary |
Robert N. Oglesby DVM
Moderator
Username: dro
Post Number: 17669
Registered: 1-1997
| | Posted on Wednesday, Jan 31, 2007 - 6:00 pm: | |
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