Dr. David Frisbie: You would have to be more specific about injections ie what is being injected. In general injections into the joints are done with compounds that are typically more potent than oral products. I assume you are referring to ramard equine total joint care, i am unaware of any published literature that proves this formulation works. Bute is not a long term solution fo soreness; i would consult you veterinarian for more specifics.
Dr. Craig Shoemaker: Depending on your horses problem injections could be very useful. I NSAID's are helping that is a good sign. If you are concerned about potential side effects you might consider topical treatment with a product like Surpass
Dr. David Frisbie:Yes they can. I would suggest a diagnostic work up by a veterinarian that is comfortable working up back issues. It is important to remember that most back problems are secondary to lower limb soreness.
Dr. David Frisbie: 1.)The typical intraarticular therapy of steroid and HA runs from 100-300 depending on region of the US and is usually a one time treatment/injection. 2.) IRAP usually is around 1,200-1,800 for drawing, processing and 3 treatments/injections.
Dr. David Frisbie: The success rate for the surgery is between 50-70%
Dr. David Frisbie: The two oral supplement I recommend are Cosequin ASU and Platinum Performance ASU.
Dr. Craig Shoemaker: Yes, Surpass can be used with Ultrasound.
Dr. David Frisbie: Substances that are building blocks for joint tissues when injected in remote sites such as muscle can make their way to the joints.
Dr. Craig Shoemaker: Surpass is safe for use in race horses but it can test. I recommend you speak with your veterinarian about specifics regarding racing.
Dr. David Frisbie: I typically follow-up using x-rays once every year or every other year if things don't seem to have changed much clinically.
Dr. David Frisbie: Good question, although there is no definative anwser at this point. The products are different and we believe there are values of both. Alternating the products seems to be a common approach that has some merit.
Dr. David Frisbie: IRAP can be an effective treatment for early ring bone.
Dr. Craig Shoemaker: Oral HA products have been shown to be effective, however, intra-articular treatment is in my opinion the best approach
Dr. Craig Shoemaker: All NSAID's have the potential for side effects. Equioxx is more specific in its action so has some safety advantages.
Dr. David Frisbie: I would suggest consulting your veterinarian about injecting the affected joints. Typically knee joint don't fuse without surgical intervention.
Dr. David Frisbie: Would not do anything unless the horse is showing soreness but if this is present irap is a good consideration.
Dr. David Frisbie: If you have active soreness that you are treating with Adequan I would treat every 4 days for 7 treatments and then continue twice a month. If you are using it in a preventative method I would start treating twice a month.
Dr. David Frisbie: I have had a 60-70% return to work in horses with menical damage, so i would consider this option
Dr. Craig Shoemaker: Actually, Surpass can be used a number of ways, it really depends on the individual case. It can be used after riding if needed or daily for the recommended treatment period. There really isn't a problem using with other oral products.
Dr. David Frisbie: There is evidence that intraarticular polyglycan is beneficial. I am unaware of any peer reviewed work that has been published on the benefits of iv polyglycan even though it is being used this way. It is worth while noting this product is labeled for intraarticular use.
Dr. David Frisbie: No that is not true. You should only inject when inflammation and soreness are present. It is true that once arthritis starts is can be an ongoing process, like in people. This is independent of treatment.
Dr. Craig Shoemaker: You do not need to shave the site prior to applying surpass to the indicated joint
Dr. David Frisbie: I believe that of the products that are available today you would be better of giving legend or adequan because they are more potent.
Dr. David Frisbie: I usually rest them for 24-48 prior to return to work.
Dr. David Frisbie: I would suggest that you have Jack worked up including diagnostic blocks to pinpoint exactly what region and or joint (s) are involved and then develop a plan from there.
Dr. Craig Shoemaker: PSGAG's have been shown in certain studies to be effective given both IM and IA. In most cases the IA approach is best in my opinionbeth
Dr. David Frisbie: I would consider surgery for the stifle OCD if that is what is causing the locking problem. Meds are typically not the answer for OCD.
Dr. Craig Shoemaker: I personally don't know a lot about Vaxamine EQ. Other NSAID's like topical Surpass might provide you with apitional comfort when treating your horse.
Dr. Craig Shoemaker: Stem cell would be a consideration, although i will warn you arthritis in the fetlock joint can be tough.
Dr. Craig Shoemaker: I prefer IA steroids...internal blister might also be of benefit
Dr. David Frisbie: I would try Surpass 1st and then shockwave if that did not work. Fusion or surgery would be a final step.
Dr. Craig Shoemaker: We have done some controlled testing on conquer oral ha and have found not signficant beneficial responses in horses with oa, thus i cant recommend it based on my scientific experience
Dr. Craig Shoemaker: Lyme disease can be very difficult; usually it is a shifting lameness. I would pursue further diagnostics to make sure it is Lyme. kris
Dr. David Frisbie: Noise or popping can be independent of soreness so if your horse is not sore I would not worry about it.
Dr. Craig Shoemaker: Much like people not all horses require supplements. A role of thumb might be as the level of work/athletic activity increase the chances of joint related problems can increase. This might be the time to start joint supplements. Definitive evidence that oral supplements can protect against disease is sparse although evidence that they can help once disease is present is more convincing.
Dr. Craig Shoemaker: A well balance diet is sufficient.
Dr. Craig Shoemaker: Little work has been done with these products.
Dr. Craig Shoemaker: There are other oral supplements that provide more scientific evidence of a significant beneficial effect such as asu (avocado/soybean unsaponifiables).
Dr. Craig Shoemaker: It appears to have less of the side effects you mention. This is believed to be because of less systemic absorption.
Dr. David Frisbie: There is more supportive evidence for ASU products (avocado/soybean unsaponifiables).kris
Dr. Craig Shoemaker: Yes, injections of the joint can be beneficial for "navicular syndrome"
Dr. Craig Shoemaker: HA and corticoid steroids are often times given together. It is possible to treat the horse with PSGAG's at the same time as well.
Dr. David Frisbie: The cost to have the cell harvest, processing and injection usually runs from 1,900 – 2,500. This would be bone marrow based, which is what I would recommend.
Dr. Craig Shoemaker: In most instances the lower hock joints will fuse naturally over time. Surgical fusing of joints is successful 50-70% of time.
Dr. David Frisbie: I might consider having the navicular bursa injected with HA and steroid if you veterinarian feels this area is the source of pain.
Dr. Craig Shoemaker: Surpass is safe for use in race horses, however, you need to be aware of testing issues surrounding its use in this group. I would suggest that you speak with your veterinarian about the specific rules and regulation in your state.
Dr. David Frisbie: It works on the soft tissue around the joint which can be the issue if the horse is non-responsive to joint injection.
Dr. Craig Shoemaker: The topical product, Surpass, has been used successfully to treat soft tissue injuries. Surpass is more expensive than Bute but the technology and aped safety are benefits other NSAIDs don't provide
Dr. Craig Shoemaker: The label use of Surpass is a fiven inch ribbon twice daily for up to 10 days. The nice thing about Surpass is that you can tailor the treatment based on your horses issue and use
Dr. David Frisbie: I would suggest trying injecting the joints that are sore directly, I use Vetalog and Hyvisc.
Dr. David Frisbie: The fetlock joint is a little less forgiving than other joints.
Dr. Craig Shoemaker: In moderate DJD of hock intra-articular injections (corticosteroids/HA) are helpful. Surgical fusion runs approx. $1900.00.
Dr. Craig Shoemaker: The penetration of the liposomes used in Surpass have a limited depth...however, surperficial inflammation can be responsive to treatment.
Dr. David Frisbie: It has been show to have effects that last for greater than a month after administration. I would suggest using it twice a month IV.
Dr. Craig Shoemaker: Surpass has ad vantages due to the liposomal delivery technology. This allows you to treat locally without a great deal of systemic uptake.
Dr. David Frisbie: It depends on the joint you are fusing. This would be something to discuss with you veterinarian regarding all of the surgical and potentially non-surgical options.
Dr. Craig Shoemaker: Liposomes help deliver the NSAID diclofenac across the skin to the deeper structures.
Dr. David Frisbie:Some horses have osteophytes in their hock without signs of pain. So “hock spurs” are not always the same as soreness. I would retreat the hock when it becomes sore again.
Dr. Craig Shoemaker: Early inflammation or when swelling/heat appear is when you'd initially want to start Surpass treatment. IA steroids/HA have a different mechanism of action. I would continue use of Surpass in conjunction with these other products...there is an apitional benefit with Surpass in these cases.
Dr. Craig Shoemaker: Absolutely, in the older horse population or with chronic OA Surpass is a great choice due to the lower amount of systemic absorption. You can treat the joint, not the entire body
Dr. David Frisbie:It can be helpful in the right hands for diagnosing joint issues, especially in the stifle. It is joint dependant.
Dr. Craig Shoemaker: Boehringer-Ingelheim.
Dr. Craig Shoemaker: Sorry, ringbone is typically associated with repetitive trauma/stress or acute injury. Factors like conformation also play a role
Dr. David Frisbie:Try this reference "evaluation of avocado and soybean unsaponifiable extracts for treatment of horses... Kawcak CE, Frisbie p, McIlwraith CW, Werpy NM, Park RD. Am J Vet Res. 2007 Jun;68(6):598-604."
Dr. Craig Shoemaker: Depends on the corticosteroid used and the degree of disease and use of horse. For high motion joints I recommend triamcinolone (Vetalog)tion such as hock Depomedrol. Vetalog has been shown in studies to be protective.
Dr. David Frisbie:You can not actually see cartilage on an x-ray but in some joints they are more narrow when the cartilage is missing.
Dr. Craig Shoemaker: You should not use Surpass in conjuction with other topicals especially DMSO. DMSO use will damage the liposomes that carry the drug and render the product ineffective. It also has the potential to change testable drug levels in performance horses
Dr. David Frisbie:Corticosteroids, specifically Vetalog, when used appropriately are safe and effective and have not been proven to have long term side effects on the joints.I would go with Legend 2X a month if you need to use one or the other.
Dr. David Frisbie: I would go with Legend 2X a month if you need to use one or the other.
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