Talk to me about tildren

mavandkaz

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So long story short.. horse has been diagnosed with a whole host of problems, including issues to all 4 suspensories, changes to the vertebrae in the base of his neck and in his back. (All thought to be chronic)
Original vet was at a loss and so we tried rehab (8 weeks walking in hand, then slowly built up ridden walk work over 6 weeks).
Needless to say he did not improve, and also began to show signs of discomfort when being ridden (10-15mins 3times a week) I wasn't happy with the very vague and non-committal attitude of the vet so got a different, very well respected vet out for a second opinion.
Honestly I have never seen a horse move so badly when lunged on the hard, and it was whole body.
Second vet is very to the point and thinks there is very little that can be done, so before completely retiring him we are going to try turning him away for a year just on the off chance it helps.
He also suggested administering tildren before turning away, as he thinks he has bone pain in multiple places. He said he hasn't used it in years but in this case it's probably the best and only possible treatment.
Will be speaking to the vet again tomorrow to get a clearer picture but wondered if anyone had any experience of using tildren.
 

ycbm

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All four suspensories? Has anyone considered ESPA?

Sorry, not the question you asked. I have no experience of tildren but I do have some of ESPA and that's what is coming to mind with the description of his issues.


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mavandkaz

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All four suspensories? Is anyone considered ESPA?

Sorry, not the question you asked. I have no experience of tildren but I do have some of ESPA and that's what is coming to mind with the description of his issues.


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Please tell me more, never heard of it (I don't think) and certainly not been mentioned by any vet.
Both vets, and myself, think that the suspensories are a bit of a red herring, or at least not the main problem.
Extensive nerve blocks were carried out, with very little change in his movement. He doesn't look too bad on the soft, but awful on the hard.
His suspensories are all showing issues to varying degrees, but it's always at the point where they meet the bone, both top and bottom, both branches.
 

ycbm

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Equine Systemic Proteoglycan Accumulation. Used to be known as Degenerative Suspensory Ligament Disease. Have a Google of the symptoms and see how many fit, but difficulties with all four suspensories should have raised this as a possibility. Unfortunately, many vets don't know anything about it.

The horse I know which almost certainly had it sounded just like yours 'lame all over his body'.

It's caused by the daily wear and tear all horses get being repaired with proteoglycan instead of muscle/tendon/veins etc. It causes the breakdown of soft tissue throughout the body, but it often shows most obviously in the suspensories, hence the early name, which can cause the pasterns to drop or the suspensories to go rock hard. If they go hard and lose their stretch then they will pull off the bone as yours have.

Diagnosis is by nuchal ligament biopsy, which I think Leahurst can analyse.

The horse I know of had six months rest but was still clearly very uncomfortable, and PTS. I'm sorry I can't offer a brighter suggestion.

.
 

mavandkaz

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Ah yes dsld. Yes it was mentioned, but in a ' I'm pretty certain this isn't it'. I know it's basically a death sentence and they don't last long post diagnosis.
We think his have always been like this and it's just the scans that have shown it.
Second vet thought the suspensories weren't the problem at all and has seen plenty others that are similar but have not caused long term issues (he works a lot for one of the big racing yards in the area)
He's convinced the main issue is bone pain
 

ycbm

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OK, it seems odd not to mention it but not to conclusively rule it out with a biopsy, since it causes exactly the symptoms you're describing, suspensory ligament issues in multiple limbs and all over body pain due to an inability of the soft tissue to hold the bones together properly. There is a difference between the suspensories not being the cause of his current lameness and not being a symptom of the underlying problem. Yes it is often a death sentence but if he has it he'll be in pain all the time and it seems both pointless and a shame to turn him away for a year only to find he's exactly the same or worse in a year's time and PTS then.

Sorry, I know this isn't the question you asked. Please ignore me if this input isn't welcome.

.
 

Red-1

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Yes, I know one who came back to useful work after lameness and Tildren. It was a long job, time off and loads of walking, but a huge improvement after the Tildren.

A couple of years later and a second 'dose' did not have such a dramatic effect.
 

milliepops

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I know a horse that had it as part of the treatment plan for a spavins/PSD diagnosis. The horse is in full work now.

Be aware that Tildren is not without risk, have a google of the renal failure side effect that is rare but pretty dire if it happens to your horse.
 

emfen1305

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I am not sure I can help but my cob has just had tildren for a diagnosis of navicular disease in one foot. He seems much better but he's also had the kitchen sink thrown at him with shockwave and sterioid injections as well as no work just turn out so not sure what has made him feel better exactly! Good luck with your horse.
 

mavandkaz

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Thank you all for your input. Seeing as it appears to be my only option to aid any possible recovery I'm thinking I probably will go for it.

@milliepops yes I have heard about the renal failure, and presume this is why it's not as popular as it once was. But I can't work out if that's more from multiple doses or just one.

@ycbm a friend had her horse put down from dsld just before Christmas, after only owning it for 6 months. So am aware of just how awful a condition it is. Have messaged new vet to ask if he thinks it's a possibility, ready for when we have proper chat on Wednesday
 

Goldenstar

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I have used Tilden and while I have never found it to be a magic bullet I think in your situation you have to give it a try.
I would also be having long acting steroid injected where the changes are in the back before turning away .
 

hopscotch bandit

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A friends horse had it for their horse, it was for spavin I think. Had three courses of it over a year to cram in as much as possible under insurance. Horse was given a anti colic injection before as there is a chance of colic, especially if it is infused fast (its given in a drip into the main jugular vein over 3/4 hr - 1hr). But sadly it did nothing for the horse and she went with chemical arthrodesis in the end which worked.

I thought there was a more modern thing now like Osphos although I believe that might be a Bisphosphonate also. Cartrophen is available too, but not sure what that tackles.

They were going to give my Dad the human equivalent of Tildren to prevent fracture in his bones as his cancer had metasised to his bones - he had to go to the dentist first as it can do something to the jawbone in humans - I don't think it applies to horses. I can remember talking to the consultant at the hospital one day about the use of Bisphosphonates in horses - namely Tildren. He was fascinated by the fact they gave this to horses as well as humans and was asking me all about it - not that I knew much lol

You might as well give it a go M&K. There is nothing to lose. I believe it was around £700 in 2010/12.
 
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mavandkaz

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Thanks for replies.
I spoke to vet the other day. He is convinced that the suspensories are not the issue, and wasn't overly concerned about what he saw on the scans.

He prefers tildren over osphos due to the way it is administered - he has seen quite a few horses have reactions at the injection sites with osphos, and leaves them very sore.

The tildren will be administered slowly over 90mins, and will be split over two doses, 6 weeks apart.
But first they will run bloods to check that he has no kidney issues.

Feel a bit better to have a plan of action, now just need to organise everything
 

hopscotch bandit

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Thanks for replies.
I spoke to vet the other day. He is convinced that the suspensories are not the issue, and wasn't overly concerned about what he saw on the scans.

He prefers tildren over osphos due to the way it is administered - he has seen quite a few horses have reactions at the injection sites with osphos, and leaves them very sore.

The tildren will be administered slowly over 90mins, and will be split over two doses, 6 weeks apart.
But first they will run bloods to check that he has no kidney issues.

Feel a bit better to have a plan of action, now just need to organise everything
I remember one of the side effects with my friends horse was the amount of wee he did the following day! She said his floor was soaking wet and she had to put two bales in to make up the amount of bedding that was saturated. :) I'm glad your vet has given you the go ahead. Best wishes
 

mavandkaz

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No.
He is absolutely fine in himself. Full of energy, will happily trot, canter and gallop round the field. Hasn't had a temperature. And not heat or swelling anywhere.
 

hopscotch bandit

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Mine had a Tildren drip, it did not have any effect. Mine had hock arthritis.
Strange that was the same result for friends horse (reply 13). I wonder why it only works on some? Guess its like people, some get good results, others nothing. I can remember you went for the surgical fusion in the end. How is your horse now? (sorry to hijack post).

OP interesting about running bloods first, that didn't happen to friends horse I'm certain of it. They have obviously got more data on the subject now than they did in 2010/2011 era when it was carried out. Luckily he was fine and still going strong after his ethanol fusion was successful. Good luck with it all anyway.
 

LaurenBay

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Strange that was the same result for friends horse (reply 13). I wonder why it only works on some? Guess its like people, some get good results, others nothing. I can remember you went for the surgical fusion in the end. How is your horse now? (sorry to hijack post).

OP interesting about running bloods first, that didn't happen to friends horse I'm certain of it. They have obviously got more data on the subject now than they did in 2010/2011 era when it was carried out. Luckily he was fine and still going strong after his ethanol fusion was successful. Good luck with it all anyway.

I went for the injections to fuse as I didn't want her to have the surgery. We had about 7 months after where she was incredible, we had so much fun together. Unfortunately she did go lame again, I had 2 different vets and both recommended I retired her. I was lucky enough to take on some land so I retired her there for over a year. She had a lovely retirement, but in Nov 2018, she started to struggle and she lost her sparkle. I had her PTS before the winter set in. x
 

hopscotch bandit

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I went for the injections to fuse as I didn't want her to have the surgery. We had about 7 months after where she was incredible, we had so much fun together. Unfortunately she did go lame again, I had 2 different vets and both recommended I retired her. I was lucky enough to take on some land so I retired her there for over a year. She had a lovely retirement, but in Nov 2018, she started to struggle and she lost her sparkle. I had her PTS before the winter set in. x
Oh I am sorry to hear that. I thought it had been successful for you long term :(
 

Hormonal Filly

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Noticed no difference at all with my mare after having Tildren, she had a entire host of problems too. It was mainly for the severe hock arthritis but I am sure it did nothing.
 

LaurenBay

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Oh I am sorry to hear that. I thought it had been successful for you long term :(

Thank you, unfortunately nothing I tried had much success. Vet did mention I could try Athramid. But one of the hocks was so bad at this point that he only gave it a 20% chance of working. I probably would have tried it, but insurance had run out by this point and I had already racked up a bill trying other things.
 

Marmaduke

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My horse was given Osphos for severe navicular damage, found on xray and nerve blocks (age 14). The vet wanted six weeks box rest, i did field rest instead (he didnt run around a lot). No difference after the six weeks, very lame on hard circle. I went for MRI, this confirmed navicular damage was historic not active and it was coffin joint and a subchrondal bone deformity causing problem, not picked up on xray. There was never any soft tissue investigation though. I stopped jumping (he was low level eventing) took shoes off, he is still doing dressage on soft surfaces. He probably has all sorts of neck, back and other arthritis going on, in addition to his spavins but as an ex racer at 19 I would expect this. He was put in heart bar shoes at the age of 4 as was always sore due to very flat feet and despite every different shoe/ no shoe over time, I expect he has been holding himself badly all his life to alleviate foot pain and often looked full body lame/ broken. I'm not saying your horse is the same but rest, no shoes and good foot balance and only soft surfaces, not the Osphos worked. Hope you make some progress.
 

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When Tildren was first being prescribed I read a comment on the UDBB from a human orthopaedic surgeon who said she would never use it. Today I read about the down sides of steroid injections into joints in humans. I think we are messing with things we don't really understand yet, plus we're treating the symptoms which are all mainly as a result of repetitive stress damage, even if they appear as a sudden injury and to that end I think the only thing I would look at would be pain relief in retirement, if I wanted to do more with the horse for whatever reason I'd be looking to a proper rehab looking to rebuild the horse's posture and way of going which is ultimately the only way of fixing what caused the issues in the first place. I would take advice on whether using anti inflammatories AND doing rehab would be ethical/viable.
 

mavandkaz

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I questioned both my vets about administering pain relief to then be able to rehab. One, just doesn't like the idea of it as it's not fair on the horse. The other, thinks that in this case there are just too many problem areas to treat individually, and so we need to treat the whole horse - hence the suggestion of tildren. He hasn't used it in years, and is only suggesting it as he thinks realistically it is the only option in terms of 'treatment'.
I am still considering just turning away without any meds. My concern is that since his diagnosis in may, he has done very little other then in hand rehab, and in this time he has gotten worse, so I can't really see how just turning away will lead to improvement.
I am worried about some of the side affects and this will be a one off dose. Even if it makes a huge improvement which then wears off in 18 months time, he will not get another dose. My hope is it will kick start bone 'remodelling' and therefore remove pain in the problem areas so that he can then be worked (probably just hacking) in a way that will build correct muscles etc, to ensure long term soundness/comfort.
I suppose I am still struggling with how he went from being about to make our medium debut and training at advanced medium, to not being happy walking under saddle in such a short space of time, without suffering an injury.
He is still perfectly happy charging about his field, and is bright and happy in himself.
 

hopscotch bandit

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I suppose I am still struggling with how he went from being about to make our medium debut and training at advanced medium, to not being happy walking under saddle in such a short space of time, without suffering an injury.
He is still perfectly happy charging about his field, and is bright and happy in himself.

I'm sorry if I've missed this somewhere along the way but would it be worth getting an osteopath or physio to have a look at him and evaluate him from their point of view?

I don't see how he could have changed so dramatically without something major having happened to him, either becoming cast in the stable or doing handstands in the field. But sometimes physios can pick up things that vets can't, often through feel and musculature development/atrophy.

Its amazing watching my physio at work and how she is able to pinpoint issues in my horse just through feel of muscles. She was able to diagnose a problem with her young horse way before her vets could find any issues because of her 'trained eye' so to speak. It might be worth a shot. Just get a ACPAT registered physio if you do decide to go down that route, there are probably plenty to choose from in your neck of the woods.
 
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