Rockley Farm. Exciting evidence emerging in Navicular

[ozpoz]

I'm not sure if following a protocol for drug trials is the way forward in this case. Surely a way to collect and examine all the existing info and evidence would be a better starting point.

 

[criso]

(navicular is notoriously misdiagnosed for example, so MRIs may well be necessary here). If, for example, you have a specific treatment for navicular but you make a mistake and include horses with foot ligament injuries in your trial you will never know whether the treatment is effective or not.



.

Then we need to dismiss published research on traditional methods that I saw when I was reading up when my horse was having problems as it

1) Combine both bone conditions (navicular cysts, changes to the navicular bone etc) and soft tissue injuries
2) Was not blind
3) Did not have a control group
4) Used subjective evaluations by asking owners to fill in questionnaires about their horses lameness pre and post treatment
5) Did not MRI after but used the work level of the horse post treatment to judge recovery.

So while this desire for perfect research is great I don't see it being replicated for other treatments for similar issues.

What I find interesting about about this which is the one constant we were always told with all the treatments was that once there were changes to the bone it could not be reversed, that was a fixed no matter what. Now we have a few cases (not research) that contradict that and that in my mind should be enough for anyone interested in horses feet from a professional point of view to take a second look and ask if there's something going on that should be investigated further.

 

[Orangehorse]

Because the results haven't been "officially" made, even reviewing the literature wouldn't be possible for veterinary research students, as the literature doesn't exist, let alone undertaking research into outcomes - or could they? Or would be a bad move career-wise?

But I agree that most of the horses sent for rehab to Rockley and other places have already been through the standard veterinary treatment of remedial shoeing, injections, etc. and several have had the "PTS" verdict.

What is needs is a retired research scientist/or vet who has a mission to bring this information to the veterinary profession who has the time and correct methodology to collate all the information that is available. Any volunteers?

 

[cptrayes]

Because Nic Barker is writing posts on her blog challenging the traditional opinion that navicular is a degenerative disease. She may or may not be correct. I absolutely hope she is, btw. But the scientist in me squirms when I read claims like this being made without robust data backing them up. Vets are scientists and scientists need high quality, reproducible, published data to be convinced of new treatment approaches. Without it, the Rockley rehab approach will never be accepted by the veterinary profession as a mainstream treatment.

Are you happy that current treatment protocols for palmar and caudal hoof lameness have none of what you are asking for?

And if so, why would you be resistant to a more effective protocol that does not have it either?

Your assertion that vets will never accept a barefoot rehab without it is clearly incorrect for three reasons.

1. They already use an approach which has NO research meeting your or Booboos requirements. Lack of research of a decent standard is clearly no barrier. My horse is having a kissing spines ligament desmotomy in one week. There's no research of the standard you require for that either.

2. There is one vet doing it already, because he has seen it work and has an open mind.

3. Because owners are already beginning to refuse conventional treatment and demand barefoot rehabs, because they work.


Just because evidence is anecdotal does not make it untrue.

Nic is not 'claiming' anything without evidence. She is posting picture after picture of horses which leave her care either sound or markedly sounder and which generally go on to perform at or above their previous level. This is not a 'claim', it's visibly a fact, a.s is reversal of damage in five horses.

If you doubt it I suggest you pop along to Milton Keynes Equestrian Centre in September, where you can see the whole place taken over for three days by people riding their Rockley Rehabs.

 

[cptrayes]

Booboos.

Hardly any veterinary medecine meets the demands for research that you have so lengthily listed above.

No treatment protocol for foot lameness, including laminitis, does. No treatment for kissing spines does. No treatment for laryngeal hemiplegia does. Those are just the ones I know personally. There are thousands more.

If a procedure clearly works, as the new interspinous ligament desmotomy operation that my horse is having done next week does, then it is simply adopted into the mainstream. And in this particular case, extremely quickly too.

You also seem unaware that 'navicular disease' meaning navicular bone damage, is very, very rarely found without soft tissue damage. And since 50% or so of horses xrayed have navicular bone changes, and those changes do not correlate at all strongly with lameness, and a lame horse returns to soundness once the soft tissue is repaired ....

then


the evidence is strong that the overwhelming majority of 'navicular disease' is actually collateral ligament,impar ligament or ddft damage inside the foot.

 

[Leg_end]

Because Nic Barker is writing posts on her blog challenging the traditional opinion that navicular is a degenerative disease. She may or may not be correct. I absolutely hope she is, btw. But the scientist in me squirms when I read claims like this being made without robust data backing them up. Vets are scientists and scientists need high quality, reproducible, published data to be convinced of new treatment approaches.

What Nic is stating on her blog is fact and is one I have seen with my own eyes. If I had the latest X-rays available I would post you the comparison pictures.

The vet profession state that Navicular is degenerative - if you have bone damage (as my horse does) then the prognosis is very poor. On the 25th Sept last year my vet told me that I would be lucky if B returned to light hacking and that the only way we would return to dressage would be on bute. Buddy went to Rockley in Nov 12, he was sound in Jan 13, was in full work by end of Feb, did his first dressage test in April and started jumping (on grass & surface) in July with a tentative aim to do his first event at the end of Sept.

He had his X-rays last week, just under 11 months after his original diagnosis and 6 months after returning home from Rockley and my vet was amazed that we had actual, positive changes on the X-rays.

As far as I understand there are 4 other horses who have had secondary X-rays/MRI post Rockley and all have shown improvement and evidence of healing/healed issues. The reason there are only 5 of us is that most horses at Rockley are there as a last change Saloon and have reached their insurance limit so if their horse is sound why would (or should) they spend hundreds or thousands of pounds to prove a point? I must admit it is something I plan to do again and keep track of as I am so interested to see if we can completely undo the damage that was caused and how long that will take.

 

[Holly Hocks]

I've been reading this and it seems that the scientists are wanting the proof and research to show that barefoot can work. Would it be possible for one of you science bods to point in me in the direction of the research to show that remedial shoeing works please. I'm genuinely interested. Thanks.

 

[Buddy'sMum]

Leg_end - I'm not denying that you and other owners had fantastic results with your horses. Really, I'm not. And I'm genuinely happy for you. All I've said all along is that I still would love to see these data published. Because I really think that's what it's going to take for the veterinary profession to take notice.

 

[Buddy'sMum]

I've been reading this and it seems that the scientists are wanting the proof and research to show that barefoot can work. Would it be possible for one of you science bods to point in me in the direction of the research to show that remedial shoeing works please. I'm genuinely interested. Thanks.

Well, I suppose I'm one of the 'science bods'!? I've been waiting for someone to bring this up, surprised it's taken this long!! I'm not arguing with you - my own horses are unshod so I'm not exactly an advocate of farriery. And, clearly, remedial farriery doesn't work in the long-term in navicular cases. BUT it remains part of the traditional treatment algorithm. So what I'm saying is, publish the data showing the fantastic, ground-breaking data for barefoot rehab and change the treatment algorithm. Because waiting for one vet and a few owners to spread the word is going to take far too long.

 

[Buddy'sMum]

Are you happy that current treatment protocols for palmar and caudal hoof lameness have none of what you are asking for?

No, not at all. But they are established protocols. I'm not saying I agree with them - what I'm saying is that in order to challenge established protocols, you need robust, reproducible, published data in support of an alternative.

Your assertion that vets will never accept a barefoot rehab without it is clearly incorrect for three reasons.

1. They already use an approach which has NO research meeting your or Booboos requirements. Lack of research of a decent standard is clearly no barrier. My horse is having a kissing spines ligament desmotomy in one week. There's no research of the standard you require for that either.

2. There is one vet doing it already, because he has seen it work and has an open mind.

3. Because owners are already beginning to refuse conventional treatment and demand barefoot rehabs, because they work.

1. OK, so if we take KS as an example - since the Croomer technique data was first published last year the technique has received a lot of publicity and is fast gaining acceptance among vets worldwide. Hope all goes well with your horse next week.

2. One vet already? Great. And how many years has that taken?

3. Some are, yes. But most will continue down the traditional treatment path because they trust in their vets and farriers. And the majority of vets and farriers think barefoot is quackery. And as long as we only have anecdotal evidence in support of barefoot rehab, that's not going to change anytime soon.

Just because evidence is anecdotal does not make it untrue.

No, of course not, but anecdotal data is less credible than peer-reviewed, published data. Fact.

Nic is not 'claiming' anything without evidence. She is posting picture after picture of horses which leave her care either sound or markedly sounder and which generally go on to perform at or above their previous level. This is not a 'claim', it's visibly a fact, a.s is reversal of damage in five horses.

OK, please publish these data then. And just maybe navicular treatment algorithms will change for the better in my horses' lifetimes.

 

[amandap]

Well, I suppose I'm one of the 'science bods'!? I've been waiting for someone to bring this up, surprised it's taken this long!!

Some of us have asked this question a few times on here and no substantial or follow up research has been cited. One or two very small, short term studies as I remember.

What galls me is the current protocol is based on traditional thinking and treatment not backed up by rigorous research and it doesn't work in the long term, in fact is palliative yet new thinking has to be subject to rigorous science to even be considered.

This all brings to the fore the causative factors, caudal hoof pain/discomfort causing improper biomechanics which stresses ligaments, tendons and eventually erosion of the navicular bone. This is the thinking I am familiar with and tbh I don't know what the traditional thinking on causation is. If the former thinking is correct then it leads directly to Rockley style rehab... strengthening the caudal hoof, through enabling correct movement (including hoof landing), exercize and diet.

Horses can become sound with damage to the navicular bone so that in itself isn't the key to soundness and useability.

 

[Booboos]

1. They already use an approach which has NO research meeting your or Booboos requirements. Lack of research of a decent standard is clearly no barrier. My horse is having a kissing spines ligament desmotomy in one week. There's no research of the standard you require for that either.

I don't know why you keep making claims that only take two seconds to refute. Here's published research on ks ligament desmotmy.

http://onlinelibrary.wiley.com/doi/...sCustomisedMessage=&userIsAuthenticated=false

It's a small study which is exactly where Rockley could start at, but if you notice there is a control group, a specific way of diagnosing (a difficult) problem, the same post-treatment protocol, etc.

 

[cptrayes]

I don't know why you keep making claims that only take two seconds to refute. Here's published research on ks ligament desmotmy.

http://onlinelibrary.wiley.com/doi/...sCustomisedMessage=&userIsAuthenticated=false

It's a small study which is exactly where Rockley could start at, but if you notice there is a control group, a specific way of diagnosing (a difficult) problem, the same post-treatment protocol, etc.

Thank you for that Booboos. Most reassuring. I couldn't find it when I googled it.

Now if you could just find me similar research for current conventional treatment of foot lameness we could all get out of this revolving door we are stuck in.

We ALL want research published

But with no money to be made out of the answer, quite the reverse for most vets, I can't see where it's easily going to come from

 

[ester]

I think given the lack of quality evidence in either direction it will be a numbers game, currently many more horses undergo traditional treatment and of those some remain sound (at least for a time) therefore giving vets anecdotal evidence that it can work. As/if numbers of horses going barefoot instead increases, with some success that anecdotal evidence will build up and it will be taken on more (which has already been identified as happening).

I cannot see it ever reaching the proper scientific results point, those who do it are doing it, get sound horses, job done. - they have no requirement to see quality data. Those that aren't doing it just wouldn't be interested enough. It would also be a project that required a fair bit of funding with regards to the imaging - and even postgrads aren't that cheap . Plus I can't imagine anyone wanting to take it on for a postgrad project- the intro/literature review for my thesis on a bug that was only isolated in 1989 (quite recent as bugs go!) was bad enough .

 

[Booboos]

Thank you for that Booboos. Most reassuring. I couldn't find it when I googled it.

Now if you could just find me similar research for current conventional treatment of foot lameness we could all get out of this revolving door we are stuck in.

OK I see the problem! Sorry it should have occured to me. This is how you access research, which includes vet, medical, humanities, etc, anything you want:
- not Google, never Google. It brings up the crazies and you can't tell the wheat from the chaff!!! What you want is Google Scholar (go to Google, click on "More" the top right tab, then "Even More" and scroll until you find Scholar. Scholar indexes peer reviewed journals and academic books, all you need is the right keywords.

- most papers are accessed either if you pay or through an academic institution. If you are somehow affiliated with a university you will have access to them for free, but the public have to pay. There is a big movement in academia pushing for free access and gradually more and more people are putting things on the web for free. Once you know what you want check out Academia.edu you may find it there for free, or the person's website, they may have uploaded the paper. If all else fails, e-mail the author directly they may well send you a copy.

- when you find one relevant article check the references for further leads. Also look up the author's personal webpage because usually people follow lines of research and have more than one papers in the same area.

- if you know the book you want and you are looking for a specific reference in it, try Google books. It only allows access to small parts of books but you may be lucky.

- other ways to get access to specific papers/books are the British Library which has an online lending system. For a fee they will photocopy and e-mail you an article or a chapter off a book. Your local public library will have an inter-library loan system where for a smaller fee they will get the book/journal for you. If you are anywhere near London or Boston Spa you can visit the British Library directly.

- you may end up with more info than you know what to do with, after all not all published research is equally good. Try looking for papers that are Reviews or Literature Reviews that give an overview of what is available in an area as they will also include a critical discussion of the relative merits of different studies. Also of huge importance are meta sites that judge the importance of particular research studies (they will use a number of factors such as number of participants, double-blind requirements, control groups, etc.) and collate the results of many studies, see for example for medical research:
http://www.cochrane.org/about-us
http://www.york.ac.uk/inst/crd/about_us.htm
http://www.hta.ac.uk/about/index.shtml

As for research on shod horses and navicular I think we need to narrow it down as Scholar shows 4,110 articles for the terms "navicular disease in horses". If you know the name of the Prof at Leahurst who specialises in navicular use Scholar to look up all his papers, that should be a good start.

 

[cptrayes]

Booboos I've been given examples by various people of the best research they can find for both laminitis (given to me by a vet) and navicular. They all suffer from similar problems, often very small numbers and always no control groups.

My favourite study for remedial shoeing had a big number. The started with 82 horses if my memory serves me correctly. They deemed 27 to be beyond help and shot them. The remaining 55 were all remedially shod and around half of them improved short term. Some of those were described as not noticeably lame, so how they claimed them in the 50% that were improved is beyond me.

And of course 27 out of 87 is nowhere near a 50% success rate, and we won't even start to talk about the fact that 'improved' was not defined and is definitely not 'cured'

Thanks for your guidance Booboos, but the only research I am interested in is recent stuff I am aware of indicating that conventional treatment for foot lameness in the navicular spectrum returns only around 20% to work, and many of those only to unstressful work on good surfaces.

It would be a pointless waste of my time to find and read any research returning results like that when what people all over the country are achieving is, anecdotally, at least four times as successful.

I've been closely involved with three myself.

1. A horse gifted to me when his owner cancelled an appointment to have him put to sleep after I offered to try and sort him out. Lame for over a year, adequan, tildren, HLA, remedial shoes, still unsound. Barefoot rehab, sound in twelve weeks. Still sound and in full work, dressage winner, showing winner, occasional hunter three years and counting.

2. A horse I used to own. Leahurst gave him a 20% chance of ever cominv back to any level of work, after maxing out his insurance with scintigraphy and MRI Owner sought a vet who would refer to Rockley and rejected the suggested treatment by Leahurst. Horse was sound inside eight weeks (it was already barefoot) and remains sound two years approaching now.

3. Gifted to me. Unsound on and off through remedial shoeing and periods of rest for the best part of five years. Sound and hunting fit in four months.

With continuing results like these, why would anyone want to see any research behind remedial shoeing and drugs, even if it existed? But no one I challenge has ever found any that comes anywhere near meeting the standards you laid down earlier, so I don't currently believe that it exists.

 

[cptrayes]

I think given the lack of quality evidence in either direction it will be a numbers game, currently many more horses undergo traditional treatment and of those some remain sound (at least for a time) therefore giving vets anecdotal evidence that it can work. As/if numbers of horses going barefoot instead increases, with some success that anecdotal evidence will build up and it will be taken on more (which has already been identified as happening).

I cannot see it ever reaching the proper scientific results point, those who do it are doing it, get sound horses, job done. - they have no requirement to see quality data. Those that aren't doing it just wouldn't be interested enough. It would also be a project that required a fair bit of funding with regards to the imaging - and even postgrads aren't that cheap . Plus I can't imagine anyone wanting to take it on for a postgrad project- the intro/literature review for my thesis on a bug that was only isolated in 1989 (quite recent as bugs go!) was bad enough .

I agree with you completely here Ester.

 

[amandap]

Thanks for those instructions Booboos.
The scholar brings up some fascinating abstract reading about Navicular shoeing options.
I find them fascinating as many are around the pressures exerted on the N. bone by DDFT and concentrate on comparisons between wedging and shoeing options in the main. One article (Hickman) disagrees with Rooney's assertion the N. bone forms a constant angle of insertion for DDFT (my interpretation ie so the angle doesn't change and cause the tendon to pull it's attachment) which I found very interesting. It appear overwhelmingly clear this is considered a degenerative disease and 'treatments' are around alleviating symptoms to enable usefulness as long as possible.

ps. After my little foray into the science I have to believe ester is correct. The difference in fundamental thinking is huge as far as I can understand.

 

[Buddy'sMum]

Thanks for those instructions Booboos.

Thanks Booboos! PubMed http://www.ncbi.nlm.nih.gov/pubmed is also excellent.

 

[Leg_end]

http://rockleyfarm.blogspot.co.uk/2013/08/research-facts-evidence-and-reasons-for.html

 

[amandap]

Thanks Leg_end. Just came to post that myself.

 

[cptrayes]

Thanks Leg_end. Just came to post that myself.

Me too

Looks like we haven't been claiming enough, doesn't it? I've been suggesting 80% improved, but it's actually 100% in Project Dexter, most of those back to full work and not the typical conventional treatment result of 'He's sound but of course we don't canter on hard ground or jump any more'.

If only we could collate all the private rehabs too. I've done two and know another, two out of three successful. The failure had a bone spur and I would be very wary of trying to rehab any horse with a bone spur.