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Message |
    
kerry bixby (Parfait)
| | Posted on Monday, May 27, 2002 - 9:15 pm: |   |
My mare tested sore in the distal intertarsal and tarsometarsal (new found knowledge)joints of both legs. She had flexions, radiographs and observed calcium growth. The vet wants to inject with "unfriendly" cortisone to encourage fusion. The mare is 6 yo. No hock problems up to this point that I have known about. I nixed the idea and am pushing for a therapeutic approach of HA and a nice cortisone. I seem to be loosing the battle here. Sure would be nice to know what I'm talking about.
Plus, after reading that "pin the tail on the donkey scenario" where the vets couldn't get the injection site right, heck maybe I ought to forget the whole thing and breed the mare...
Can you advise on the typical type of cortisone used, the length of rehab after the injection, If you have ever fused chemically and how long I expect the shot to last (more than 2 weeks)?
Thanks Dr O!!!!
This site is the bomb
Kmb |
Robert N. Oglesby DVM (Dro)
| | Posted on Tuesday, May 28, 2002 - 6:55 am: | |
Hello Kerry,
Am I understanding you correct, that the horse has no symptoms yet they want to begin extensive treatment on the basis of flexion tests alone? If this is infact the truth I find this incredible and do not know of any work to support such a treatment plan. I can think of many reasons not to including prolonged lameness while you wait for the uncertain future fusion.
To learn more about the significance of flexion tests see Equine Diseases: Lameness: The Diagnosis of Lameness in the Horse.
DrO |
kerry bixby (Parfait)
| | Posted on Tuesday, May 28, 2002 - 10:25 am: | |
Well, I have been looking for any information on the use of chemical fusion and I couldn't understand why that was being presented as my only option when he promised that this "nice " cortisone would work for only a few weeks and then I would see that I would HAVE to fuse...She is heavy on the forehand under saddle and swaping leads behind. The mare is a little out of shape but she was wringing her tail so I thought she needed an exam. That's why I had him out ten days ago. I'm not sure that I understand the tone of your note but I really am presenting the whole story here. The vet is due out this afternoon...He is an old leg guy and has worked the tracks since Hector was a Pup. Does many barns I respect. I don't get it cuz he has been conservative in the past. Can I get the injections I want? |
kerry bixby (Parfait)
| | Posted on Tuesday, May 28, 2002 - 10:30 am: | |
Gosh Dr. O.
I'm sorry! I didn't even thank you for your response. I must have fallen and hit my head or something. Thank you! You must never sleep. I sound grouchy too. Sorry. Thanks for your kind help as always.
Kmb |
Robert N. Oglesby DVM (Dro)
| | Posted on Wednesday, May 29, 2002 - 6:30 am: | |
I still feel like I am missing something here so I will try to just answer your questions rather than figure out what is going on.
There is a description of the different corticosteroids used in the joint and whether they are short, medium, or long acting in the article, Equine Diseases: Lameness: Diseases of Joints : Arthritis and DJD: An Overview. Look under the heading of intrarticular medication.
There is also a discussion there about the thoughts of whether they are friendly or unfriendly, though these are hypotheticals based on in-vitro studies and we really do not know if one is better than the other for the joint environment and it may depend on the circumstances.
No one knows how long a shot of steroids in a joint will keep a horse sound when given. Just because it is long acting does not mean it will keep him sound a long time and vice versa. It depends on dozens of factors or which the most important is how healthy and stable the joint is when the injection is given. The type steroid used in based on a clinical judgement which included the degree of lameness, radiographic changes, and what the veterinarian is familiar with.
I have never fused a hock joint intentionally, I have always been able to manage them with injections and NSAID's. I am unaware of a steroid regimen that is routinely used to fuse a joint.
DrO |
Vicki Zaneis
Member
Username: Vickiann
Post Number: 134
Registered: 3-2005
| | Posted on Wednesday, Nov 2, 2005 - 10:13 am: | |
Dr. O -- RE: cortisone shot/infection: Interesting article in the Orlando newspaper today. After 3 years of misdiagnosis, being ill and losing weight, a correct diagnosis was finally made after analyzing bone chips from the pelvic bone of Gator football player Jarvis Moss. He had a staph infection feasting on his body for almost 3 years after a cortisone shot to the hip. He had been misdiagnosed with everything from gastritis to a hernia, urinary tract infection, and just being lazy before the truth was finally found. 6 weeks of IV antibiotics plus nutrients made him well again. Just wanted to post this in case there are horses out there that could be similarly affected. |
Corinne Meadows
Member
Username: Corinne
Post Number: 84
Registered: 9-2005
| | Posted on Wednesday, Nov 2, 2005 - 10:32 am: | |
Vicki,
I have found your post most interesting. I am working on therapeutic modalities in my grad school studies of sports medicine at the United States Sports Academy. Do you mind if I bring your finding up in class? It should yield a terrific discussion.
v/r
Corinne |
Vicki Zaneis
Member
Username: Vickiann
Post Number: 135
Registered: 3-2005
| | Posted on Wednesday, Nov 2, 2005 - 2:24 pm: | |
Of course -- I am all for sharing information that helps others. More than likely you could pull up the entire article on this on the internet at OrlandoSentinel.com --- It is on Page D 1 (Sports) in the November 2, 2005 paper. "Moss making up for lost time." |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 14034
Registered: 1-1997
| | Posted on Thursday, Nov 3, 2005 - 8:14 am: | |
An interesting case for sure but not really useful as a diagnostic example for members. More of an example of what NOT to do I would say. When faced with a diagnostic challenge you should NOT start with a list of diseases in your head and then try to make the clinical signs you see "fit one". You start with the clinical signs and then try to discover the pathological process producing them. Once the pathology is accurately defined, then is the step where you confidently work on a diagnosis.
Perhaps the same backward process described above is what delayed the correct diagnosis of the Gator. They took a set of clinical signs, did not find the pathology, and tried to make it fit a disease. It was not until the pathology was found that the correct diagnosis could be made.
DrO |
Vicki Zaneis
Member
Username: Vickiann
Post Number: 136
Registered: 3-2005
| | Posted on Thursday, Nov 3, 2005 - 10:43 am: | |
My point is that if a cortisone shot has been given and the patient is in worse pain and suffering after it, with increased and new signs of illness that continues, the possibility of such an infection should at least be considered. Unfortunately, this malady was allowed to progress to the point of complete and painful physical collapse with this young man unable to stand, straighten up or even get dressed. The doctors (who I am sure are GREAT doctors) blew it on this one, and team doctors even thought he "was just complaining a lot." Coach Meyer intervened and had four doctors run tests to find the cause. What you say about how to make a diagnosis is correct. Too many medical diagnoses are made in a rapid try this, try that, hit or miss manner, (without looking at all the facts) and too often symptoms are treated without addressing the actual pathology, which continues, grows and destroys. And in some cases, the creed of "do no harm" is violated. |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 14048
Registered: 1-1997
| | Posted on Friday, Nov 4, 2005 - 9:15 am: | |
We do not know enough of the specifics of the above case to make the conclusions you draw Vicki. I often find newspaper reports terribly inaccurate. You are making a diagnosis (the doctors blew this one) without knowing all the facts. As presented it does represent an example of how not to practice medicine. When treatment is given and illness worsens, reevaluation should be done. But I am not ready to condemn the doctors or the therapy given or use it as a diagnostic/therapeutic basis for cases in the future.
DrO |
