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Discussion on How long can you feasibly inject joints?
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Kathryn S. Engler
| | Posted on Friday, Dec 10, 1999 - 3:40 pm: |   |
Hi! Dr.O-I have a 13 yr. old Appendix QH (16'1) His hocks are fusing and he's navicular in front. My vet says he has what she calls "peppered hocks". There are blockages in the joint (I guess partial or spotty fusion) consequently when she does inject, the cortisone and hyaluronic acid don't penetrate very far. She's not optimistic that they will ever fuse. (Is that unusual).. Unfortunateley, when he gets injected it only lasts for 2 months which isn't good-I give him an injection of Legend monthly-he gets cortaflex,isoxaprine (70 a day since June) and aspirin daily (or Bute when he's really bad.) For a while I was doing a Legend one day followed by an adequan daily for 4 days and than another Legend.(once a month) (And painting the joints with DMSO) He's been rested. He's got frog pads on the front which help. But I can't keep him sound. When his hocks flare up he transfers the weight to the front and than his navicular flares up. After injecting I'll get about 20 minutes of sound riding time daily for about two months. (light hacking in large areas-we were doing training level dressage) Also-I do have him turned out all day. The vet said I could have the joint drilled to aid in the fusion process. Put him out to pasture for 6 months and maybe he'd be O.K. Since this is a painful procedure-What will that do to his navicular front end? Should I nerve him in front too? I could turn him out permanently but will he be uncomfortable if he doesn't get the injections every 2 months? And how many times can you inject the joints? Would I be better putting him down? Might his hocks fuse on there own? (I'd hate to put him down if there's a chance they will fuse but he's so uncomfortable now without the injections- he gets so he can barely walk-he is dramatically better after the injections but it doesn't last) I just don't want him to suffer. What is your opinion?
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Robert N. Oglesby DVM
| | Posted on Saturday, Dec 11, 1999 - 8:27 am: | |
Fusion is hard to predict, I would not be negative about it but when...is a hard question to answer. I am also unable to predict what will happen to the bilateral front limb lameness when the back limbs are treated, if work makes thems worse so will bilatterally painful backlimbs. If I have to inject a joint more than once (or an occassional twice) a year I figure the horse is working too hard for it's condition. It is at this point that the injections may be doing more harm than good is the reason for this limit.
If there is a chance he will fuse, why don't you turn him out to pasture for a year and see if it does not occur naturally? Be sure he gets regular trimming and keep those front toes short for the fornt end lameness.
DrO |
Kathryn S. Engler
| | Posted on Monday, Dec 13, 1999 - 5:28 pm: | |
Thanks for getting back to me. I have had this horse for eight years so we're more than just a little attached. I want to do the best I can for him. I guess I will turn him out and see what happens. I know I am running up exhorbitant bills in the process-do you think he will ever be sound enough to ride again. I know it's hard to predict. Even if his hocks fuse we still have to contend with the navicular.
Should I leave his shoes on? He gets quite lame without the frog pads. Should I keep up the joint supplements,aspirin,isoxuprine and Legend? Probably not the isoxuprine-I know how you feel about it-it seems to be the current trend- almost every horse at the H/J barns in our area are on isoxuprine as a daily supplement!) I can't say that I've seen any significant changes while he's been on it! Anyway I look forward to your input. Thanks!
Kathy |
Robert N. Oglesby DVM
| | Posted on Tuesday, Dec 14, 1999 - 7:01 am: | |
There are two theories on horses requiring pads: take'em off and toughen the feet or leave'em on so the horse stays confortable. Without looking at your horse I cannot make a recommendation. Which ever you do I believe bilaterally front foot sore horses need to have their toes kept short, rolled, and rockered if at all possible. A 4 week shoeing / trimming cycle is usually required.
I have been looking for a reason to justify Isoxsuprine use for 15 years, and still have not found one, it is amazing how a medication can become so routinely used without an once of proof of clinincal efficacy. Now there are studies that provide evidence of lack of a clinical affect with the currently recommended oral doses.
I think you should be using an oral chondroitin sulfates and glucosamines (run a search on these terms with no time limit, you will find lots of recommendations).
I would be using the Legend only if that much money for a little bit of response is acceptable however there do seem to be consistant small responses with it. Legend is much more effective at getting the mildy arthritic "stiff" horse going but not at taking a really lame horse and getting him going again.
I would be using bute instead of aspirin (see the medication: antiinflammatory sections). The specific recommendations will depend on your goals and fincial situations and what your vet is comfortable with.
DrO |
Kathryn S. Engler
| | Posted on Wednesday, Feb 23, 2000 - 5:16 pm: | |
Hello Dr. O,
Many things have transpired since we last corresponded. I learned about a new treatment being done at Purdue University's Large animal clinic. It's called equitripsy-the same principle as lithotripsy in humans where gall and kidney stones are broken up with a shock wave conducted through water. I sent my horses x-rays down. 6 of his joints were involved-both lower and middle hock joints and both navicular joints and they found a hock spur forming as well-which accounts for him being unable to get comfortable with all four legs having problems. The good news was that even though all those joints were effected none of them were too terribly damaged. They rate the joints on a scale of 0-5, 0 being sound and 5 being dead lame at the walk. All of his joints were 2's except the right front navicular-which was a 3. You can usually expect to improve one lameness grade. If we achieve a 1 he'll be show sound again. The cost was quite nominal (considering what I've spent on Legend, Adequan and having the joints injected every couple months. It runs $250/joint but it's still less than a new horse or paying upkeep on an unrideable horse for another 10 or so years. The biggest risk involved is the anesthesia but that didn't prove to be a problem. He had the procedure and came home the next day. Walked off the trailer and into his stall. They said I could give him a little bute the first day or two if he was sore and-that's it. It's totally non-invasive, there are no incisions or stitches so no chance of infection. Recovery time is 6 weeks. 1 week total stall rest than the following 5 weeks of stall rest with a 10-15 minute hand-walk once a day. We just passed the three week mark and it's all I can do to try to keep him to a walk. His legs look perfect-he keeps letting me know he's feeling fine. He used to stock up and that's not even happening. The insurance company was so fascinated when I sent them the information that they have agreed to remove the lameness exclusion from my policy if he vets out when I return for my follow-up visit in three weeks. I want to post this website here because I really think this could be beneficial for many other horses. They treat tendons and other ailments as well. The Doctor's name at Purdue is Scott McClure-I believe the Doctor that pioneered this procedure is in Oklahoma and recently another vet was approved to perform this treatment in California. The treatment's trademark name is "Shockwave" and this is the link http://www.shock-waves-inc.com or you can check out the Purdue University website. I'll keep you posted. The real test will be when I get on and ride him again-I can't wait!! I hope this information will be of benefit to many others.
Kathy |
Pamela Griffin
| | Posted on Wednesday, Feb 23, 2000 - 9:03 pm: | |
Hi,
Thanks for posting this. My pleasure trail horse has arthritic hocks, has had many injections and now Legend is keeping her very comfortable. I'm glad to know that there is something else I can do in the future if I need to. Thanks for the info! |
Robert N. Oglesby DVM
| | Posted on Thursday, Feb 24, 2000 - 10:06 am: | |
Hello Kathryn,
I cannot tell you how much I appreciate the members who keep us informed as to how their cases are doing. Some come and ask questions and we never get any feed back. Others come and keep us appraised with objective facts and we learn so much from these.
I went to the shock-waves site and was a bit disppointed on the lack of scientific information available. Though they list the titles of many scientific references there are no summaries and many do not apply, even perpherally, to common equine lameness issues. I do have the greatest respect for Dr. McIlwraith who they list as having just joined their board and next time I have him on the phone I will ask him about it.
Do continue to keep us informed!
DrO |
Kathryn S. Engler
| | Posted on Thursday, Feb 24, 2000 - 11:25 am: | |
Hi! Dr. O,
I agree the site could be more informative. After I read the FAQ's I contacted Dr. McClure at Purdue and spoke to him a number of times. He was terrific to work with. Than I discussed it with my vet and the vet at the clinic where I took my horse this past summer when we couldn't figure out what was wrong with him. They all thought it was worth a try. They were intrigued as neither had ever seen any horses that had received this treatment as it's relatively new. It's going to be a long three weeks playing the waiting game. I don't know who's more raring to go-me or my horse. I'll definitely let you know how this all turns out. It's just nice to know that there are viable new options. One of the suggestions initially was to drill his hocks and nerve him in front and that didn't seem like a great option to me. So lets keep our fingers crossed!
Thanks,
Kathy |
Kathryn S. Engler
| | Posted on Friday, Mar 24, 2000 - 11:59 pm: | |
Hello Again Dr.O,
I am ecstatic! It's been seven weeks now since the Shockwave procedure. I've been back in the saddle for a week and a half. My horse went back down to Purdue yesterday for his follow-up exam. His hocks are 100% perfect. His navicular is almost 100%. There was a slight lameness in the front right (the worst of the six joints treated) but only when trotted on the asphalt! Dr. McClure said it is completely imperceptible in the round pen or in the sand arena. He has been proclaimed show sound-and was given a final injection in that right front coffin joint to clear up any lingering inflamation. My regular vet thinks he'll be fine-she said considering he's been on stall rest for 6 weeks, and his feet were extremely long and he has no pads-no one would believe this was the same horse I had considered putting down two months ago when he could barely walk and was on every conceivable anti-inflammatory. I am extremely sensitive to any lameness that he exhibits and I am so pleased because he really does seem fine. I'll continue to keep you all up to date. I hope other people will consider this treatment as a first resort and leave the surgery as a last resort.
Kathy |
Robert N. Oglesby DVM
| | Posted on Saturday, Mar 25, 2000 - 8:48 am: | |
Hello Kathryn,
Let's take this slowly, though I can see you are sold on this treatment, I also see a lot of other procedures where done and time alone can heal many problems, particularly arthritis where fusion is taking place. You have to understand if this is really the boon to arthritis that you seem to think this would be some of the most important medical news of the year, yet I see nothing in the literature specifically on this yet. I will research this further.
DrO |
Marion Dickinson
| | Posted on Saturday, Mar 25, 2000 - 1:56 pm: | |
Wow! This does sound wonderful. But like Dr. O, I am wondering why I have not read about this anywhere in my numerous horse publications. |
Kathryn S. Engler
| | Posted on Tuesday, Mar 28, 2000 - 11:16 pm: | |
Hi Dr. O and Marion,
I know that this may not be the miracle cure. I was fortunate that none of my horse's joints were horribly effected but because all of his legs had problems-he was not even "serviceably sound". He could barely walk so this is extremely exciting-to be back in the saddle with the prospect of showing again. Once the hocks are fused,they are fused-that should not present anymore problems. I know, that's not the case with the navicular. This treatment has relieved the pain for now and since he can now carry his weight on the back end that should help keep the navicular from worsening too rapidly. Given the alternatives-which were few and undesirable-I could not be more pleased. I've ridden my horse 10 times now. Walk, trot and cantering he feels great-very comfortable with himself again. When they get that sore they become very tentative but he's moving freely again. I'll continue to post because it would be great if anyone else can benefit from this treatment. It isn't well known. The reason you haven't read about this treatment,Marion, is because it is in the research stages. I opted to participate because my horse was so crippled and there were no good options. I'd tried all the drugs and injections which no longer worked-I even considered putting my horse down because he was so miserable. Yet none of his legs, individually, was that bad, but collectively he was crippled. So I had nothing to lose. Actually, they have been doing this procedure in Europe for a number of years. Dr. McClure just came back from Switzerland where he was observing and seeking funding and equipment. He laughs-because there are many people following this program, he said some of his critics think he just dreamed this up one night. It's not something he invented, he's just working with the treatment to see if it's viable and to see if he can refine it in any way. He was very pleased at how well my horse did-he said that there are some horses that don't get any results. This is as disheartening for him as the owners, but happily he has more postive results than not. I merely relate my experience as food for thought- for someone else that loves their horse and has run out of options and is willing to try something new. After this-I'd start with this treatment before any type of surgery-it's non-invasive-and less expensive than surgery. Worse case you don't get any result-than you can always opt to try surgery. If I had, had his hocks drilled- I sure wouldn't be going riding tomorrow-oh happy day!!!
Kathy |
KATHLEEN WHEAT
| | Posted on Wednesday, Mar 29, 2000 - 5:40 pm: | |
Why is it that we keep hearing about procedures and medications being used successfully by vets in Europe for many years, that the vets here say they know nothing about. Is it because they don't do "clinical studies" in Europe? Does a "clinical study" have to be done to make it worthwhile trying in this country? Just a thought.
Kathleen |
Robert N. Oglesby DVM
| | Posted on Thursday, Mar 30, 2000 - 8:00 am: | |
Well,
I think in large measure this is due to the grass being greener on the other side but less stringent legal requirements and a much less litagative populace do make more treatments available, whether useful of not.
DrO |
Fran Cilella (Canter)
| | Posted on Thursday, Feb 7, 2002 - 9:20 am: | |
Dr. O,
I read the above discussion with great interest after running a search on lithotripsy. I just ran across a paragraph in an equine magazine that this procedure has been used to date successfully on hock arthritis (that was virtually all that was said in the article)
The reason for my great interest is I have been struggling to keep my 10 year old TB sound for the past several months. In October, I sent him to MSU for X-rays and was very surprised to find he had arthritis in his hocks (rated 4/5 on a scale of 1 to 10). He had not previously come up lame (the reason for the trip was a new trainer thought she saw iregularity in his movement and thought it might be due to an old stifle problem that we had (I thought) successfully worked through I immediately stopped jumping him after the diagnosis and switched to dressage, thinking it would be beneficial to strenghten the whole back end and support those weak joints. Since neither of us have done dressage before, we started at the absolute basics.
Anyway, since then, he's been sound for a week, off for a week, or two. This week, he will receive his first dose of Legend and he will have had 4 to 5 more weeks off before I attempt to ride again. Anyway, the info on Lithotripsy really caught my eye as I have had the bad feeling that my beautiful boy is breaking down faster than anyone ever expected despite the best of care and he may have to be retired, or if we can't keep him pasture sound, it breaks my heart but I have to consider euthanasia. After running a search on it and reading the above info, (which is now a year old) I was wondering if you have any new info on the procedure and would love to hear an update from Kathryn on how her horse is a year after the procedure.
Thanks for any info you can provide. |
Robert N. Oglesby DVM (Dro)
| | Posted on Friday, Feb 8, 2002 - 6:54 am: | |
Hello Fran,
No I haven't Fran. Though extra-corporal shock wave therapy (ESWT) continues to be available clinically and are written up is some journals there is still no scientific work on efficacy and procedures. In general Fran this procedure has been recommended for non-joint soft tissue and soft tissue-bony tissues indications and in one clinical series was thought to be effective for inferior check ligament desmitis. There was a german paper I have been unable to access that lists "spavin" as an indication.
Most importantly in a review given by Dr McIlwraith just two months ago of current and upcoming therapy for arthritis, ESWT was not mentioned. Dr. McIlwraith is arguably the most knowledgable man in the world when it comes to equine arthritis.
DrO |
Fran Cilella (Canter)
| | Posted on Friday, Feb 8, 2002 - 1:20 pm: | |
Dr. O,
Thanks so much for your speedy response. When I read the blurb on lithotripsy in the article, I was hoping for one more option in case the Legand has no efficacy on my horse (I've read it works for some, doesn't help for others)
Like so many others, I am nearly desperate to help my equine buddy as there are so few palatable options for a horse that is no longer sound.
Thanks again! |
Cathy Miller (Buddil)
| | Posted on Saturday, Aug 24, 2002 - 9:58 pm: | |
Kathy, I was wondering if you are still a subscriber to this site and would love an update on your horse a few years after his shock wave therapy. It has become a real "thing to do" in my area and I am seriously thinking of having it done to my 8 year old warmblood that suffers from spurs in his lower joints of both hocks. We are injecting every 4-6 months now and even then he is not totally comfortable. Would love an update or a response from anyone out there that has had this therapy done! Thanks so much!
Cathy |
barbara carry (Oscarvv)
| | Posted on Sunday, Aug 25, 2002 - 11:01 am: | |
Cathy
I was wondering where you are located that so many people are doing this?
I have only read about this type of procedure here.
Do you know where this procedure is being performed?
~Barbara |
Cathy Miller (Buddil)
| | Posted on Sunday, Aug 25, 2002 - 11:18 am: | |
Barbara, I live in Illinois, near the Wisconsin border. It is being done at Illinois Equine in Naperville, Illinois and Dr. Merrit's office located in Wauconda, Illinois. My vet in Bristol, Wisconsin has many people that have had this therapy done on suspensory injuries, has had one of his patients try it for navicular, which it did not work on him. A border at my barn had it done on a torn suspensory and she has just started him back slowly after 3 months. The ultrasound showed no tear anymore whatsoever. I also just spoke with a friend of mine that had her mare done in her hocks and navicular and she said she is now sound and is ready to go back to work. I think it sounds too good to be true but it is supposed to be non-invasive and can not make them any lamer so I quess it is worth the try!
Cathy |
barbara carry (Oscarvv)
| | Posted on Monday, Aug 26, 2002 - 12:33 pm: | |
Cathy
Thank you for the information. 
I am in Florida (near the UF Vet School) and am going to ask my vet if she has heard of this procedure.
~Barbara |
Kathy Herring
New Member
Username: T0bian0
Post Number: 2
Registered: 8-2002
| | Posted on Tuesday, Apr 29, 2003 - 4:38 am: | |
I have been using Micro-current to treat my barrel racing horse for 2 years now. I finally retired her (she is 23) and we are now doing Dressage and trail riding. The site to contact is www.therapyproducts.net This lady has done all the homework and research for us. You can buy a unit and treat your horse yourself. I had x-rays done on her hocks and one was fused the other in the process. Micro-current makes her much more comfortable so they can fuse quicker. Also, I have done Phoresing instead of injections. This procedure is on the web-site also. It is less invasive and my horse was rideable two days after a flare up with her hocks after the phoresing treatment. |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8272
Registered: 1-1997
| | Posted on Tuesday, Apr 29, 2003 - 5:51 am: | |
Hello Kathy,
I cannot find the term phoresing in the medical litereature. Though transcutaneous electrical stimulation (TES) shows promise for pain reduction in human osteoartrtis of the knee, lack of standarization of technique and varying results indicate that without studies (human and horse) to test various currents, times, and electrode placement, that this is shooting in the dark. Currently (no pun intended) there are no such studies in horses so buyers beware: this may be an expensive boondoggle.
DrO |
Maureane Hoffman
Member
Username: Maureane
Post Number: 2
Registered: 10-2002
| | Posted on Tuesday, Apr 29, 2003 - 7:00 am: | |
I think the term may be pheresis (or iontopheresis). It refers to moving the drug through the tissues with an electric current. |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8274
Registered: 1-1997
| | Posted on Tuesday, Apr 29, 2003 - 8:24 am: | |
Thanks Maureane,
I searched on "iontopheresis" and got a bunch of returns for "iontophoreses" somehow. Anyway, it is as your definition states. This appears to be a science which has had a rapidly burgeoning amount of research lately. In summary there is work to suggest that this process will help deliver drugs through the skin. For example:
J Pharm Pharmacol 2002 Jul;54(7):907-12
Electrically enhanced transdermal delivery of a macromolecule.
Badkar AV, Banga AK.
Department of Pharmacal Sciences, School of Pharmacy, Auburn University, AL 36841, USA.
The purpose of this study was to establish the delivery parameters for the enhanced transdermal delivery of dextran sulfate (MW 5000 Da). Full-thickness pig skin or epidermis separated from human cadaver skin was used. Silver-silver chloride electrodes were used to deliver the current (0.5 mA cm-2). For electroporation experiments, one or more pulses were given using an exponential decay pulse generator. The correct polarity for iontophoresis and pulsing was first established as cathode in the donor. The amount of drug delivered increased with increasing donor concentration up to a point, but not any further. The amount delivered also increased with pulse voltage, the delivery being twice as much as with iontophoresis alone (144.5+/-10.35 microg cm(-2)), when 6 pulses of 500 V were applied at time zero before iontophoresis (276+/-45.2 microg cm(-2)). It was observed that the amount delivered was a function of increasing pulse length when the apparent charge delivered was kept constant. Transport through pig skin (107.4+/-24.4 microg cm(-2)) was found to be comparable with that through human epidermis (84.9+/-18.4 microg cm(-2)). In conclusion, we have demonstrated the transdermal delivery of a 5000 Da molecular weight dextran sulfate using iontophoresis. It was also seen that iontophoretic delivery could be enhanced by simultaneous electroporation.
There are some in vivo human experiments also to suggest there may be something to this process. However there is this project in horses that was unable to find an effect:
J Vet Pharmacol Ther 2000 Aug;23(4):229-36
Iontophoresis of dexamethosone-phosphate into the equine tibiotarsal joint.
Blackford J, Doherty TJ, Ferslew KE, Panus PC.
Department of Large Animal Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville 37901, USA.
In human rehabilitation medicine, dexamethasone-phosphate is theoretically iontophoresed to localized subcutaneous tissue where conversion to dexamethasone occurs. This delivery system has recently been introduced into veterinary medicine for the same purpose. However, the pharmacokinetic justification for parenteral delivery of this prodrug remains undocumented. Utilizing iontophoretic methods that are relevant to both human and veterinary clinical practice, the present investigation compared injection and iontophoresis of dexamethasone-phosphate into the equine tibiotarsal joint, also known as the tarsocrual joint. The tibiotarsal joints of seven horses were injected with 4 mL of 6 mg/mL dexamethasone-phosphate. With a similar drug concentration and over the same application site, six different horses underwent simultaneous cathodic iontophoresis (4 mA, 40 min) or passive application (0 mA, 40 min) on contralateral limbs. Following all applications, tibiotarsal joint synovium was collected. Local venous blood samples were also collected from the iontophoretic and passive application sites for analysis of plasma drug concentrations. Because of the potential for conversion of dexamethasone-phosphate to dexamethasone, an extraction and analysis protocol was developed for both chemicals. The technique demonstrated a linear range of detection (0.39-12 microg/mL) and a capability for measuring both chemicals in plasma and synovium. Conversion of dexamethasone-phosphate to dexamethasone occurred during synovial incubation (37 degrees C) and following freeze-thaw cycles. In contrast to the measurable synovial concentrations of dexamethasone-phosphate (2.3 +/- 0.96 mg/mL) and dexamethasone (0.27 +/- 0.07 mg/mL) following injection, neither drug was detected in the synovium or the local venous blood following iontophoretic or passive applications. In conclusion, these results do not confirm iontophoretic or passive delivery of measurable dexamethasone-phosphate into the tibiotarsal joint using current clinical methods.
This is a experimental therapeutic technique that has not proven its usefulness, nor does their seem to be a known technique working in the live horse.
DrO |
Kathy Herring
Member
Username: T0bian0
Post Number: 3
Registered: 8-2002
| | Posted on Wednesday, Apr 30, 2003 - 3:24 am: | |
Dr O. There has been studies on Iontophoresis in horses. Columbine Drug at 2295 W. Eisenhower Blvd. Loveland, CO Phone 970-663-4600 Fax 970-663-7478 is now compounding Dexamethasone solutions for horses. It is NOT what the vets sell. It is pure and has no fillers or binders especially made for phoresing. This is from Columbine Drug and I quote - We are now compounding Dexamethasone solutions for horses. Research conducted in 1999 by Dr. Andris Kaneps, College of Veterinary Medicine, Oregon State University demonstrated positive results with the use of Dexamethasone Sod. Phospate 10mg/ml in Iontophoresis on horses. The synovial fluid tested postive for Dex 4 out of 5 horses and the urine tested postive in 14 out of 15 horses. Dexamethasone sod phospate 4mg/ml did not show as good a result. Therefore the 10mg/ml is much more effective and recommended. The phoresor used was manufactured by Iomed Columbine Drug compounds pure Dexamethasone Sod. Phosphate 10/mg/ml solution. It is recommended that 3ml be used for 20 minutes at 4mA. Our solutions are equipped with an Adapta-cap to eliminate the need for a needle. Imagine being able to get rid of hypodermic needles when dealing with hour horses. Simply draw up the desired amount using a syringe WITHOUT a needle attached. You can contact them for varification. I fouond a vet that is (open-minded) who called in a prescription for me and I am working with him doing a case study on my mare with the bad hocks. Thank goodness there are still some vets around who are open to alternative methods. Please not since there is not injection there are no side effects. Don't believe me - Just call Columbine Drug. |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8282
Registered: 1-1997
| | Posted on Wednesday, Apr 30, 2003 - 6:17 am: | |
Hello Kathy,
I do need to make some other comments about your post:
1) There are no "fillers or binders" in injectable dex Na - phosphate of any type.
2) The fact that 20% did not get ANY medication is a high enough failure rate to make this unacceptable as a standard treatment and does make me wonder if the rest received a therapeutic dose and variablility is received medication. Dr. Andris Kaneps is a well known researcher in horses and small ruminants but I cannot find a published paper on this.
3) There is very little reason to fear a needle.
4) To correlate no needle/no side effect is to negate that most side effects are the result of the actions of the medication when given therapeutic doses. I think there are 2 important points you do have:
a) that the incidence of iatrogenic joint infections may go down
b) If less drug is required side effects may be less
But having injected joints for 20 years I have yet to have a infected joint secondary to injection.
5) If you continue to call those who agree with you open-minded and therefore imply those who disagree with you as close-minded you will soon loose credability.
DrO |
Maureane Hoffman
Member
Username: Maureane
Post Number: 3
Registered: 10-2002
| | Posted on Wednesday, Apr 30, 2003 - 9:39 am: | |
At risk of annoying someone I feel like I should jump in to the discussion of "alternative" therapies. ANY effective therapy should be able to be studied using standard scientific methods i.e. one should be able to prove that a group of animals/humans treated with the therapy does or does not have a greater improvement in symptoms or function compared to a group that got a sham treatment or placebo. Case studies and anecdotes do not constitute proof of efficacy.
Fundamentally I see no difference between "alternative" and "conventional" therapies in this regard. Thus, I agree with Dr. O that any therapy should be supported with published, scientifically valid data before it can be recommended.
If an individual chooses to use an unproven therapy in hopes that it may do some good -- especially in a situation in which no tested therapy is available or has been beneficial -- that is a perfectly valid thing to do. One should just recognize what one is doing.
Cheers,
Maureane |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8291
Registered: 1-1997
| | Posted on Wednesday, Apr 30, 2003 - 7:02 pm: | |
Hello Maureane,
Makes sense to me. One further clarification, The Advisor uses the term alternative to mean: therapies of uncertain benefit/detriment. We have a article that further explains our thoughts of this, see the Welcome Message to the topic: BULLETIN BOARD members only » The Lounge: Kick back and relax. » Alternative Medicine and Epistomology.
DrO |
Maureane Hoffman
Member
Username: Maureane
Post Number: 4
Registered: 10-2002
| | Posted on Wednesday, Apr 30, 2003 - 8:59 pm: | |
I'm not trying to quarrel, but the acceptance of "alternative" therapies is one of my pet peeves. Your definition of "alternative" may not be the one that is generally accepted. Many people (I think including some members here) use the term "alternative" to mean techniques or approaches not developed or practiced by mainstream allopathic "western" medical practitioners. This includes herbalism, a variety of nutritional supplements, accupuncture/accupressure, homeopathy, low energy laser therapy, application of magnets and, in some cases, chiropractic manipulation. Some aspects of some of these approaches are scientifically valid and have been have been demonstrated to be so in well-conducted clinical trials. Others may be valid, but have not yet been studied in a rigorous fashion. Others are conceptually flawed and without demonatrble merit. |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8301
Registered: 1-1997
| | Posted on Thursday, May 1, 2003 - 6:09 am: | |
Hello Maurean,
Using my college dictionary as the final arbitrator your point is valid. The problem with the definition is that it makes the term useless as a adjective to help folks make up their mind as it includes "useful non-Western techniques" and excludes "non-useful Western techniques". I will look to see if I can find a term less ambiguous (or a bigger dictionary that can provide support for my position).
 DrO |
Kathy Herring
Member
Username: T0bian0
Post Number: 5
Registered: 8-2002
| | Posted on Wednesday, Apr 30, 2003 - 11:51 pm: | |
If only we didn't get defensive on techniques we don't have any knowledge about. Credablility!!! Veternarians are losing it by the hour because if they can't do it without charging up an arm and leg and we can treat our horses ourselves - they are losing money. I have found this is the bottom line with vets who are not willing to try or even look into other methods.
I am not saying injections don't work. Of course they do. BUT if I can find a non-invasive procedure that doesn't open up the skin to infection it is worth a try. I have gotten remarkable results. Any time you introduce a needle into the skin (vaccinations, etc.) you are opening up cause for an infection. Why not lessen the chance.
I am aware of the AVMA trying to get passed a law where only a licensed vet can perform certain therapies such as acupuncture, homropathy, or chiropractic medicine. They are running scared because these therapies work and they want to get in on the trend. My opinion is when they see these therapies work they want to take them over and make money off of others research and skills. Why can't we all just work together. Example if a horse gets cast in his stall and has a swollen hock. What would a vet do. Apply ice, good, cold hosing, good. Let's do x-rays. OK, x-rays look good. What else they do? Well, I would immediately start micro-current. It works on the tissue to start the healing process. The horses just love it. Refer to www.therapyproducts.com for more info on micro-current. I have seen horses with acute swelling go down after two treatments. Micro-current is safe and effective. Micro-current is probably the least understood and yet the most important modality to use. It is so valuable in the maintenance and restoring of good health that it shoue be a standard in the medicine cabinet. I use it on myself as much as my horses and I know how well it works. I subscribed to this web-site about two years ago and didn't renew. I thought I would give it another try, but I have changed my mind. Not because someone disagees with me. That happens all the time, but because of the attitude that it is done in. Please refund my subscription back to me. It stated that if I wasn't happy for any reason I could get my money back. There are many other resources out there where we aren't riduculed for introducing something that just might help a horse or person. If one horse or person is help by my post it I will be happy. |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8299
Registered: 1-1997
| | Posted on Thursday, May 1, 2003 - 5:31 am: | |
Kathy your post speaks for itself and needs no comment from me. I will move this discussion to the Alternative Medicine section if someone is looking for it, see Iontophoreses.
Seem to just keep p.o. these alt med folk, do you think it is my breath?
DrO |
TONYA BAUER
Member
Username: Pbauer
Post Number: 3
Registered: 10-2002
| | Posted on Thursday, May 1, 2003 - 4:34 am: | |
Kathy,
Please don't leave...people have different methods that have worked in their particular situation. I looked up your website and did further research on the information that was
presented.It is something I would definitely
consider.
I learn so much from this website and enjoy "iron
sharpening iron." Information is required for making the right decision...each person making their own.
Sincerely, Tonya Bauer |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8300
Registered: 1-1997
| | Posted on Thursday, May 1, 2003 - 5:36 am: | |
Tonya,
if Kathy cannot debate the issue on its merits and without resorting to such a defensive posture, name calling, and not providing any support to her contentions it is unlikely she is going to very useful member for this site. We welcome all posting but it is my job to seperate the wheat from the chaff as best as I am able so you will be able to make better decisions. My advice would be to avoid such machinary until a clear indication, benefit, and technique, is shown.
DrO |
Helen Weedon
Member
Username: Cara2
Post Number: 67
Registered: 9-2002
| | Posted on Thursday, May 1, 2003 - 8:24 am: | |
Hello folks. Dr O obviously has to come down on one side of the fence or the other as its his board! but we should all do well to remember that in the end it is up to us as individuals to choose what path we take. Dr O knows I like to use homeopathy for my horse and I am happy to SUGGEST it to other people but I would never TELL them to go out and buy. He thinks I'm wasting my money, but I've seen people do that with conventional veterinary treatment. It is true that there are many quacks out there just waiting to take our hard-earned money from us but that doesn't necessarily mean that the procedure they use is quackery.
Now this is going to be very controversial I'm sure but please do not think I mean to offend, its just another example of choice - many people who read this board I am sure are church goers and firmly believe in God, Jesus and the Bible. There is currently absolutely no proof that God exists, that Jesus ever lived on Earth or Life After Death but millions of people accept it without question. Some people take the Bible literally but as a trained geologist I can tell you that no way did anyone make the Earth in 7 days or that modern lifeforms just sprung into being. The Bible was written by men for men - in story format that was easier for uneducated people to grasp. Here in the UK we generally howl with laughter at the TV preachers you seem to have plenty of in the USA and cannot believe that anyone is taken in by them. But that's what its all about - choice.
I think that provided "alternative" treatment doesn't hurt the animal then its ok to give it a whirl and if it works for you then great. I know of one mare who had kissing spines and an alternative therapist slapped a herbal poultice on its back. Trouble was she obviously didn't know diddly squat about how any poultice works because she didn't protect the horse's skin first and it ended up with what was effectively a chemical burn. Wrong sort of treatment by an untrained person - very bad. A very good friend of mine had a problem with her shoulder and after a year of unsuccessful conventional treatment went and had a session of acupuncture. The next day she was able to move her arm in directions she hadn't managed for months - right treatment by a skilled practitioner. Yet no-one can truly say how or why acupuncture works! |
Jan Toberer
Member
Username: Jjet
Post Number: 7
Registered: 3-2003
| | Posted on Thursday, May 1, 2003 - 11:49 am: | |
Helen: Hear, hear! A voice of reason! |
Maureane Hoffman
Member
Username: Maureane
Post Number: 5
Registered: 10-2002
| | Posted on Thursday, May 1, 2003 - 12:45 pm: | |
This may be an appropriate forum to discuss the practice guidelines being proposed by the AVMA. As I understand it they recommend that states make it illegal for non-veterinarians to perform (for pay) a number of procedures that are currently commonly performed by non-veterinarians, unless the procedure was prescribed or supervised by a veterinarian. This is put forward as a means of protecting consumers from fraud and abuse, but strikes many horse owners as an attempt by veterinarians to keep non-veterinarians from competing with them for the many dollars spent on "alternative" therapies.
What do you think Dr. O?
Maureane |
KATHLEEN WHEAT
Member
Username: Kathleen
Post Number: 86
Registered: 9-1999
| | Posted on Thursday, May 1, 2003 - 1:20 pm: | |
Ditto Helen.
Maureane,
Unfortunately, this is already happening in some states. A few years back, a few veterinarians got together to get rid of equine dentists in Nebraska. The result is there is now no one who can do the quality work that was being done by some dentists. Also, I know of some horses whose owners have had to consult dentists out of state because the best Nebraska has to offer looks at the horse and says he can't do the work because he doesn't have enough knowledge to work on those with problems that are not ordinary. The can do more than the average vet, but not nearly as much as is quite often required. Personally, I don't see the difference between allowing a dentist to work on teeth or a farrier working on feet. Both have the opportunity to do great good or harm. Also, in Virginia, a few veterinarians got together and tried to convince the other veterinarians to support them in trying to outlaw dentistry by anyone other than vets. Fortunately, some of the vets notified some dentists of the statewide meeting of the vets and together they were able to keep the dentists in the state. Most vets I talked to don't want to do dentistry and recognize that they aren't equipped (physically and equipment and knowledge) to do anything but rudimentary dentistry. They refer their clients to dentists that they trust. The same applies to other fields like accupuncture, chiropractic, etc. I, for one, want to be able to make my own decisions as to who will work on my horses.
Kathleen |
Maureane Hoffman
Member
Username: Maureane
Post Number: 6
Registered: 10-2002
| | Posted on Thursday, May 1, 2003 - 1:42 pm: | |
I believe that who is allowed to do what is not up to veterinarians. The definition of what constitutes the practice of medicine (or veterinary medicine) is up to the Board of (Veterinary) Medical Examiners in each state. If something is considered to constitute the practice of vedicine, then the practitioner needs to be licensed to do it. Thus, the AVMA or other professional organization can only recommend guidelines to the state government bodies. If these recommendations are not popular with the affected public the AVMA might drop them. Also, if horse owners object to proposed guidelines we could lobby our state representatives on this topic. The problem is that we may not know when a change is being proposed or exactly what is being proposed. |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 8303
Registered: 1-1997
| | Posted on Thursday, May 1, 2003 - 2:53 pm: | |
Hello All,
You have the facts right, Maureane. The AVMA guidelines, which are being updated but I don't think have been approved yet, provide State Veterinary Boards a model to base their state practice acts on. They can choose to use them or not and all proposals must be approved by the state legislature.
Since you ask, I am a bit of Libertarian with this issue. I am not sure by what right the state or federal government draws the power to tell citizens who can and cannot treat their animals. Do I think someone would be foolish to pay someone to diagnose and treat their animals without some credentials to show they know what they are doing...absolutely. Do I think the result of less control would be lots of poor decision making...absolutely. But the government was not originally designed to protect us from ourselves, just from the use of force from our fellow citizens, the government itself, and other governments.
DrO |
Elizabeth Donahue
Member
Username: Paul303
Post Number: 337
Registered: 9-2002
| | Posted on Thursday, May 1, 2003 - 8:57 pm: | |
Dr.O mainly states just plain old facts. Whenever this discussion comes up, his comment is always that either no clinical studies have been done, inconclusive ones, or too few to demonstrate consistancy of action or result. However, when an alternative remedy has been studied, and proven, I notice that he does not hesitate to recommend it in cases where it could help. DMSO for example, has been researched, and published. It is not a perscription, nor is it even a medication - yet Dr.O is open to it's use. It is only where scientifically proven and published results are lacking, that he counsels caution. I really can't see why anyone takes offense that the acceptance of alternative medicine isn't pushed harder on this site - after all, we come here willingly, seeking the advice of a veterinarian, not an alternative practicioner. As someone else pointed out, there are abundant sites where those discussions can be found.
Now, where I live, there are not enough Equine Vets to go around. My vet would not mind having some pressure taken off her. This spring, she helped co-ordinate her visit for spring vetting, with our equine dentist so that two of the horses could be sedated for the teeth work. I then heard her making her own appointment for her horses for their teeth work. It's very common around here for Equine vets to refer dental work.
One last thing - Don't I recall discussions on this site about some rather eccentric treatments - discussed in detail - like ummm Crest toothpaste? I must admit to employing some alternatives myself, but I really don't get bent out of shape if the good Dr.O points out that the benefits do not have sufficient research....because what he says is true. Once again, I remind those who are upset - This site is mainly for veterinary medicine. When I want to investigate alternative medicine, I find the internet overloaded with sites for that. |
Maureane Hoffman
Member
Username: Maureane
Post Number: 7
Registered: 10-2002
| | Posted on Thursday, May 1, 2003 - 9:22 pm: | |
Dear Dr. O,
My Goodness! a man after my own heart -- one who knows the meaning of the term "libertarian"
Maureane |
KATHLEEN WHEAT
Member
Username: Kathleen
Post Number: 87
Registered: 9-1999
| | Posted on Friday, May 2, 2003 - 11:17 am: | |
Elizabeth,
Wouldn't it be nice if all vets and dentists, etc could work together for the good of the horses. Unfortunately, it is not always the case. So, every once in a while, we like to share our experiences and our fear of losing the ability to make our own decisions about what/who is best for our horses health. I, for one, really appreciate DrO's willingness to allow a diversity of opinions and I understand more about his cautions when it comes to unproven treatments. And in this discussion, I didn't didn't pick up on, save one person, anyone being upset. I enjoyed the exchange of information. And, by the way, I find this site a very good source of information about all forms of treatments, traditional and alternative, mostly due to DrO's policy of letting people voice their views. Because of these discussions, I have learned to be wary of some treatments that I once thought of as harmless and have also heard of and researched some treatments that I had never heard of.
Kathleen |
Elizabeth Donahue
Member
Username: Paul303
Post Number: 339
Registered: 9-2002
| | Posted on Saturday, May 3, 2003 - 1:59 am: | |
You know, Kathleen, I probably understand the alternative practicioner conundrum better than many. As a Dental Hygienist, for more than 30 years, I can only treat patients under the supervision of a Dentist. It's fine with me - that's the career I signed up for and I was well aware of the limitations. When it bugs me enough, I'll change careers. But what people often don't realize at the Dental office is that it is mainly Hygienists who pick up problems, and alert the Dr. After all, when we clean your teeth, we work throughout the mouth, and are responsible for noting anything of interest on the soft or hard oral tissues of the mouth and throat, face, neck and lymph nodes. I check BP and update medical histories. We usually have everything noted when the Dr. comes in and then he delivers "his" diagnosis. Think about it... you can't expect the Dr. to investigate everything in your mouth in his short exam. When he works on your mouth, his attention is usually focused on the one tooth he is treating. Yes, you may not realize it, but while your teeth are being cleaned, you're also getting a very thorough examination....yet for thirty years, the Dental Association has certain members that are certain we want their practices. We don't. We don't want the responsibilities, the taxes, the malpractice suits, the peer review, or the ball and chain of emergencies.
I really can't see where alternative practioners can be effectively blocked by vets. Maybe they can't write perscriptions for medication, but they don't believe in that anyway. Now, as for manipulation or massage, that really can't be blocked either. And, unless they're licensed by the state, I don't see how they can be blocked from giving you advice and herbs. However, I HAVE seen ( twice ) instances where alternative treatments have caused complications and vets were called in too late. The vets took a lot of abuse for not being able to right a problem that had been treated incorrectly for months. The alternative practioners had no one to answer to. The vets had the licensing board and peer review and their good names and reputations at stake.
Things may be different now, do alternative practicioners have peer review or arbitration? Are they licensed or certified? Can they lose anything if charged with negligence? What's the scoop? |
KATHLEEN WHEAT
Member
Username: Kathleen
Post Number: 88
Registered: 9-1999
| | Posted on Saturday, May 3, 2003 - 5:04 pm: | |
Elizabeth,
It seems that vets can effective block someone from legally treating your horse for pay. What they do is lobby to have rules/laws passed with such wording that it effectively makes it impossible or illegal for the person to do their job. For instance, in Virginia some vets were trying to make it illegal for veterinarians to sedate for dentists. Since most horses need to be sedated for at least the initial visit, it would make it impossible for a reputable dentist to do their work in such a way as to not stress the horse (or their own bodies) unnecessarily. Dentistry is not really considered alternative, but it faces the same hurdles, as many vets aren't able to keep up with the techniques and training of this developing field. I'm not sure about all types of alternative practicioners, but there is a central certifying body for equine dentists. Not all practicing equine dentists are certified, though. I worked for one and she was certified. They must pass certification and then must attend at least one of two conferences each year to continue to be certified. They cannot legally sedate a horse, so the clients schedule their own vet to be there at the same time if sedation is needed. Also, I had a chiropractic/accupuncture practicioner working on my mare. He was a licensed veterinarian who decided to specialize. I would probably hire someone who was not a licensed vet if I decided they were qualified. Some influential veterinarians in Nebraska effectively blocked equine dentists from practicing in Nebraska. The only ones who can legally work on horses' teeth for pay now are licensed veterinarians. There was a wonderful dentist named Jefferys (think that is the name) who was practicing in Nebraska and was forced out and now has an equine dentistry school in Idaho. One of my horses is with a friend in Nebraska and she has a Freisian colt that the vet/dentist examined and said he didn't understand what he was seeing in the horse's mouth, but couldn't give her any idea of who could help her. I put her in touch with a dentist in Virginia who is in the process of trying to help her long distance. The owner of the Freisian is offering to pay the dentist's airfare just to get the horse's teeth worked on. That situation is a result of veterinarians convincing the powers that be to make it illegal to practice dentristry without being a licensed vet. And as I said, some vets in Virginia tried the same thing, but other vets worked to get them voted down. So, it may be that there are not many places right now that are outlawing these alternative practicioners, but it is always a good idea to let other horse owners know of the potential for this happening where they are. It would probably be a good idea to have some kind of licensing/certification for everyone who treats or trains horses, but don't know if that is feasible. You would have a hard time getting all farriers and trainers to get certified, yet they can and do cause as much harm as someone 'treating' horses with herbal or homeopathic remedies. I guess it is up to us, the owners, to weed out the good from the bad. I've found that that is true of finding a veterinarian as much as any other person we allow to come in contact with our horses.
Kathleen |
Holly Wood
Member
Username: Hwood
Post Number: 309
Registered: 3-2001
| | Posted on Saturday, May 3, 2003 - 7:23 pm: | |
Kudos to both of you, Elizabeth and Kathleen,
Well made points . . . . We had a similar "battle" between vets and equine dentists over a year ago. It seems the voice of reason prevailed, and the dentists are allowed to practice, now. I don't know how the other New England states compare.
Holly |
Elizabeth Donahue
Member
Username: Paul303
Post Number: 340
Registered: 9-2002
| | Posted on Saturday, May 3, 2003 - 8:53 pm: | |
I just realized that, living in NJ, I think I've been spared some of these problems. Although NJ is a small, heavily populated state, there is a huge amount of horses per capita. The horse is our state animal, and there is even a lobbying group that howls first and reads later, whenever legislation is introduced. We also had a Governor, Christie Todd Whitman, who really looked out for NJ's horsepeople. USET, is headquartered in Gladstone, NJ, and the horse industry here is huge and influential. I think I've been taking some benefits here for granted. |
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