Done to death: Arthritis Management - Cartrophen, Bute, etc.

HeresHoping

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I've had a search on here for Cartrophen but posts are mostly more than 5 years old. My little mare is struggling more than usual with her hocks and it's time to talk options with the vet. She's 17, an ex brood mare and probably suffering from EMS although we haven't confirmed. Cushings negative and very low, but gets a bit cresty, has fat pads unless carefully managed (which, this spring, is proving somewhat difficult). She seems to get stiff through the winter and loosens off in the warm weather.

Last year the vet and I discussed whether to inject the hocks and he was a little concerned with the lami risk. But, she was coping very well at that point and we decided that the work and diet were doing enough and to listen to her. We listened and she was happy all the way through to December and then started to stiffen in the colder weather. She's now out over night (muzzled) and in on diet hay (soaked) during the day, nothing else as she only needs to see a food bowl to put weight on; and because she's a bit stiff, not yet up to doing enough fast work (once or twice a week) as recommended by the vet last year.

Last night she was teaching my 11 yo daughter the ropes and she was struggling with canter, particularly on the left rein which is her worse hock (she's barefoot and throws flare on the off fore to compensate). Time to discuss the next steps but I'd like to be clear on what they might be and my opinions are informed. She's probably not long for this world anyway as she is full of melanoma. I always said that if they get in her parotids or her eyes I would have to make some bigger decisions. She has now developed one on her eyelid. However, she is our darling girl and we love her to pieces.

So, any recent experiences of Cartrophen? Arthramid? New supplements? Hippy dippy options (not turmeric, I am not sure of its efficacy in horses and I have tried it; similarly, Boswellia)? And what has been the cost, if you don't mind me asking?

Thank you.
 

be positive

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As she may not have an extended life I would keep things simple and use bute, it is proven to be effective, can be increased/ reduced as and when required and should enable you to get the work in to help reduce her weight, I think people tend to dislike using it long term but I feel the benefits outweigh the risks, many of the alternatives can help but you can waste time trying them until you find the right one.

I have used cartrophen on one horse some years ago but he then had an unrelated issue so it was not easy to tell if it helped long term.
 

Scarlett

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I would try Vetrofen and Vetroflex supplements.

I have a 20yo who's mind is still that of a naughty 5yo but his body can't keep up. He's had his SI injected a few years ago and his hocks done 3 times in the last 4/5 years. He's partly retired and has a 15yo sharer who weighs nothing and has lots of fun on him.

I've never found a supplement that really made a difference until we tried Vetrofen and Vetroflex. Vetroflex is the joint supplement while Vetrofen is an anti inflammatory (it has boswellia in it) and can be bought in 2 strengths - Healthy for daily use and Intense for when they need a bit extra. We maintain him on Vetrofen Healthy and Vetroflex and add Intense if he has stiffened up due to the winter weather/has done more work than usual etc etc. This has worked a treat :)
 

southerncomfort

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Mine is a bit older than yours so probably not relevant, but when we moved up here last year I had our new vet out to give my old girl a check over and discuss possible treatments for her hocks.

His advice was that at her age he wouldn't recommend steroid injections and that targeted use of Bute was probably more appropriate. He said he'd be happy to discuss cartrophen if I wanted to go down that route but his advice was basically bute as necessary and to try a few supplements to see which helped.

During winter she had one bute every morning in her breakfast, but now the warmer weather has arrived I usually give it before feet trimming and a couple of hours before I plan to ride her.

She also has a supplement called Nil-bute which is Devils Claw, MSM and yucca and she also has Boswellia which has honestly made a huge difference to her.
 

Nari

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I'm another who'd opt for bute in this situation, it will have the added advantage if easing any aches & pains elsewhere too. I hope you have plenty of time left together.
 

hopscotch bandit

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I know a number of people who have had ethanol fusion (Chemical Arthrodesis) for their horses with quite a high percentage of horses going back into work following a rehab plan including physio, remedial shoeing and careful management.

The process involves injecting both hocks with a contrast agent which will then follow a path through the joint. The hocks are then xrayed to show the path of the dye. If the dye goes into the upper hock joint it tells the vet that the chemical arthrodesis would not be successful with that horse.

Immediately following the injection of dye (if it is okay to go ahead) the vet will inject ethanol (approx. 99% proof alcohol) and this will kill the nerves within the hock which cause the pain.The hock will then fuse although this can take up to 18 months to achieve most fuse quicker than that, one hock is often fused before the other. Once the injection has been done a rehab plan takes place, the horse can go out to grass the next day as there is no risk of laminitis as no steroid has been used.

The rehab plan means that the owner has to follow to the letter the exercise required, from memory as my friend has this done with her WB she had to walk for a week, followed by trot and then canter over a period of a period of 5 or 6 weeks before resuming jumping, the vet came out to see it at intervals to monitor how it was getting on before the work was upped. Basically the more work you do with the horse the quicker the hocks fuse. My friends horse had one hock fused 8 months later, the other was nearly fused. The horse who was around 11-12 at the time returned to the level it was previously (SJ and Dressage) and some 8 years or so on seems to be coping very well spavin wise although it has other problems unrelated to the hocks which means its just used for hacking only. Other people I know that have had it done have also had success although one horse didn't seem to make any difference - he was four. I am thinking about doing this for my mare, at the moment the steroid injections are working but if they don't I will ask her vet to see if chemical arthrodesis would be beneficial to my horse.

I think the process cost my friend in the region of £250-£300, but that's a one off cost, it never has to be repeated again. Downside if it doesn't work there is no room in the joint space for steroid injections. Here is a link which gives you more info: https://www.horseandrideruk.com/expert-advice/articles/give-it-a-shot/

And a research paper for you http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.533.2796&rep=rep1&type=pdf
 
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ester

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I put Frank on boswellia for his hock when he was 21ish, it was successful in that other people noticed the difference even though I hadn't told them. I also had to make sure I kept his physio up, I have some pre physio videos I sent to the vet about 9 months after moving him to wilts but by the time the vet came (post physio) he looked much sounder.

after about 6/9 months on the boswellia I wasn't happy with him again so he had a speculative steroid injection that worked brilliantly and I kind of wish I'd started giving them a little earlier (as he later threw up a possible compensatory issue on the other hind). I'd consider the lami risk for one joint pretty low/I think the most recent research suggests the concern for intra-articular steroids is inflated.

For the last 18 months he has been retired to hacking only and does so only on the boswellia, I have discussed injecting again with the vet but he thinks we should save it in case he deteriorates. He would be a candidate for being on some regular bute now but he's had some liver issues so we stick with the boswellia for the time being (it is all such a balancing act!)

I personally wouldn't ever do an ethanol fusion, and with your girls other issues I wouldn't be doing anything that required lengthy rehab work.

AFAIK Arthramid seems to be the last option used currently when other options have failed.

If I were you I would put on boswellia, consider getting the worst hock jabbed and consider bute if still struggling.
 

SEL

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I've used catrophen on both mine and think any benefit was short term - and only for one horse. The other showed no improvement at all. The one who showed short term improvement has advanced arthritis and is retired (his ringbone x-rays were breathtakingly awful). I keep him on danilon as and when he's looking a bit stiff and personally I think that's the best option when they get to that stage.

The other one has arthritis in her hock joints and that was diagnosed when she was only 6, so I suspect a genetic link (only lightly ridden to that point). No steroids to date because of laminitis risk, so again I use danilon when she's sore.
 

Auslander

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Not sure if this helps at all, but after a tough few weeks, I've just bitten the bullet, and put Alf on a daily bute dose. He's 21, has started getting progressively more stiff this year, and I've seen him struggle a bit to get up after rolling a few times recently. He had a chiro session yesterday, and I had a chance to chat with my vet (also his chiro). We talked about various options, but decided that, at his age, the chance of liver problems from long term bute usage weren't really an issue, as old age is likely to catch up with him before his liver starts to object to the bute. He has to stay in work, as he's a big, heavy chap, who needs to stay fit(ish), slim(ish) and active (ish!) or he will go downhill fast, so he will be on a couple of bute a day for the rest of his life. If I think his quality of life is impaired by the stiffness, or he still struggle to get up, I'll do the right thing by him immediately, but for now, the plan is to keep him ticking over for as long as he is happy, comfortable and mobile.
 

skint1

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We used steroid injections on my daughter's Tb, first time they worked amazingly well but the second time they did not work at all. I don't think I'd rush to use them again though I know they have their place. I agree with you about turmeric, my daughter tried it with him and I remain unconvinced.. For him, the most effective management tools in terms of drugs/supplements were danilon and devil's claw.

My current horse is 18 and a big fellow who has done a lot in his time. He has mild-moderate hocks and front coffin joints, he also has cushings (though very well controlled with 1 prascend) He's mainly happy hacker though he can do a bit more all things being well. he stays in during the afternoon to get a break from the grass but is otherwise out this time of year. He has a good farrier and I give him 1 danilon a day split between 2 feeds along with a boswellia/msm/glucosamine supplement, this seems to keep him in fine fettle! Too fine sometimes...
 

SEL

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Not sure if this helps at all, but after a tough few weeks, I've just bitten the bullet, and put Alf on a daily bute dose. He's 21, has started getting progressively more stiff this year, and I've seen him struggle a bit to get up after rolling a few times recently. He had a chiro session yesterday, and I had a chance to chat with my vet (also his chiro). We talked about various options, but decided that, at his age, the chance of liver problems from long term bute usage weren't really an issue, as old age is likely to catch up with him before his liver starts to object to the bute. He has to stay in work, as he's a big, heavy chap, who needs to stay fit(ish), slim(ish) and active (ish!) or he will go downhill fast, so he will be on a couple of bute a day for the rest of his life. If I think his quality of life is impaired by the stiffness, or he still struggle to get up, I'll do the right thing by him immediately, but for now, the plan is to keep him ticking over for as long as he is happy, comfortable and mobile.
I have a feeling your vet chiro is the one I have recently had out to my draft x appy (mainly because you recommended her:D ) and she also recommended danilon if it will keep them working. If you don't keep them moving then you get into a vicious circle of stiffness / not wanting to work / more stiffness etc. Exacerbated with mine in that she also gains weight quickly off work.

Also had 'the chat' about what her prognosis was if she couldn't work :(
 

HeresHoping

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Thank you very much, everyone.

I don't think fusion is an option, really, by the time all the x-rays are done it's going to be a lot more than £300. In addition, she needs to keep moving to keep her feet working; bed rest would probably result in shoes and to be quite honest, I'd rather not shoe her again unless absolutely necessary.

I think the bute option sounds like the best one. I will discuss with the vet in more detail but I am glad to have the discussion armed with more information and experience. I had her on Boswellia and Devil Claw over the winter - well, from October last year, actually, as soon as it got cooler and the grass lost its hue. She was really quite stiff through Jan and Feb, and came in from the field hopping with a bruise one day so had some time off. As it ran out I didn't replace as I wanted to see just how bad her hocks were; three weeks on, I know I need to call the vet.
 

ester

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I do think when it starts to be possibly multiple joints/locations bute is often the best plan.
 

ihatework

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I do think when it starts to be possibly multiple joints/locations bute is often the best plan.
I’d agree.
I’d also say that if you are doing anything in addition to bute I’d probably divert funds to Pentosan Gold IM, and do that monthly after the initial course
 

Auslander

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I have a feeling your vet chiro is the one I have recently had out to my draft x appy (mainly because you recommended her:D ) and she also recommended danilon if it will keep them working. If you don't keep them moving then you get into a vicious circle of stiffness / not wanting to work / more stiffness etc. Exacerbated with mine in that she also gains weight quickly off work.

Also had 'the chat' about what her prognosis was if she couldn't work :(
Olwen? She's just fab, isn't she! Alf gets an "OAP Special" chiro treatment every 8weeks, and he feels fab afterwards.
 

SEL

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Olwen? She's just fab, isn't she! Alf gets an "OAP Special" chiro treatment every 8weeks, and he feels fab afterwards.
Yes! And straight talking too. Bit hard, but actually having her tell me that there was absolutely no point in retiring to a field - it would kill fatty one way or another - was something I needed to hear.

Lots of manipulation and 48 hours later I had a different horse. Plus she pointed out that my recently re-adjusted saddle didn't fit and likely never had....
 

LaurenBay

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I would go for Bute in this instance.

My mare has hock arthritis, we tried 2 lots of steroid injections, Tildren drip, and the enthusion. Sadly none worked and she is now retired on vets advice. Vet did offer Athramid (sp?) but said doubtful it would work on her.
 

skint1

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I would go for Bute in this instance.

My mare has hock arthritis, we tried 2 lots of steroid injections, Tildren drip, and the enthusion. Sadly none worked and she is now retired on vets advice. Vet did offer Athramid (sp?) but said doubtful it would work on her.
This was like our Tb gelding, he had a good couple of years as a happpy and beloved ornament, but I know others who had a lot more, he was just unlucky
 
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