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What do you think of
Legend and Adequan for use in my Event horse? Are there any toxic
side effects, and are “generic” products as effective?
When should I use them?
I have been told that
my horse may have the stomach ulcers. How did he get these ulcers,
and how should I treat them?
What is ESWT?
What are Shockwaves?
How are shockwaves used
in human medicine?
Which horse injuries respond
to ESWT?
What is the treatment protocol
of ESWT?
What are the negative side effects
of ESWT?
How does Dr. Revenaugh feel about
ESWT?
Question: What do
you think of Legend and Adequan for use in my Event horse? Are there
any toxic side effects, and are “generic” products as
effective? When should I use them?
Answer: Legend and Adequan represent a relatively
new class of medication aimed at improving the health of horse’s
joints. They have been shown to improve the quality of lubricating
fluid in the joints, (synovial fluid), as well as decreasing inflammatory
byproducts within the joints. Adequan has an additional effect of
“protecting” cartilage by reducing inflammation within
the matrix of the cartilage.
The unique characteristics of these products are: (1) They have
virtually no negative side effects – except price. (2) Legend
and Adequan are administered systemically and therefore, all of
the joints within the body stand to benefit by their use –
including the back and neck (in addition, to all the joints of the
legs). (3) because of their safety, thay can be used frequently.
The FEI still considers these medications “performance enhancing”
and therefore, they are prohibited once a horse is competing in
an FEI (international) competition.
There are a multitude of “spin-off” medications which
have come on the market more recently: numerous oral, intravenous
and intramuscular products are widely available. To my knowledge,
these are not generic forms of the original medications. Rather,
they are variations of the same medications. It is important to
know that many of these newer products have very little “quality
control” or efficacy studies behind them. To my knowledge,
only Legend, Adequan and Cosequin have been shown to be effective.
I encourage clients to look closely at what they buy, and LOOK FOR
A RESPONSE TO THE MEDICATION. If the horse has not responded I would
save my money or try another product. As a general rule: you get
what you pay for.
Each product has it’s own specific recommendations regarding
frequency of usage. When clients consult me, I try to tailor a treatment
plan according to each individual horse and rider. With upper level
event horses, the products are typically administered before any
“maximal effort”. This would mean before a Three Day,
or before an especially big “gallop day”. The number
of treatments oftentimes depends on how hard the horse is working,
how much the horse needs the medications, and how much the owner
can afford.
In summary, I am a big proponent of these medications. They are
safe and oftentimes very effective in treating a variety of joint-related
problems.
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Question: I have been
told that my horse may have the stomach ulcers. How did he get these
ulcers, and how should I treat them?
Answer: Horses get stomach ulcers just like people
get stomach ulcers. Generally speaking stomach ulcers are primarily
due to stress. Specific reasons include: stressful transport, prolonged
stall rest, general management issues, infrequent feeding and use
of certain medications over a prolonged period of time. Medications
specifically include nonsteroidal anti-inflammatory medications
such as “Bute” and Banamine. Also high on the list is
dexamethasone.
Recent studies have shown a surprisingly high proportion of horses
suffer from stomach ulcers. Symptoms of stomach ulcers in horses
can vary depending upon the severity of the ulcers. Severe ulcers
may often cause colic or diarrhea. Moderate ulcers may manifest
as weight loss, or general “dullness”. Mild ulcers may
only present as poor performance (reluctant to jump, or a bad attitude).
There are several medications available for treatment of stomach
ulcers in horses. The treatment of choice is Gastroguard paste.
Gastroguard works by inhibiting secretion of stomach acid. ( note:
“Generic gastroguard” products are poorly absorbed by
horses) Gastroguard is an excellent product. In fact, I often recommend
gastroguard for USET horses when traveling over 8 hours. The horses
usually drink more en route, and arrive in much better shape than
they would otherwise.
Stomach buffer type products are also used widely. These can be
effective for long-term management of horses. However, stomach buffers
are generally not very effective at healing stomach ulcers!! Nonetheless,
many horses will improve their performance during competition season
if they are treated with a daily stomach buffer.
The best way to diagnose stomach ulcers is by using a fiber-optic
endoscope, (“gastroscope”) to actually visualize the
inside of the stomach. By doing so, one confirms the diagnosis as
well as evaluating the degree of severity. This technique requires
an especially long endoscope. And alternative may involve a trial
use of an anti-ulcer medication for 7 to 14 days. If the horse responds
favorably, it may be suggestive of stomach ulceration. Most insurance
companies require gastroscopy for a definitive diagnosis of gastric
ulceration.
Finally and most importantly, I recommend revisiting your management
scenario if your horse has stomach ulcers. Most horses with ulcers
will do better with more pasture turnout, more frequent meals, and
some friendly neighbors. There are many variations on these themes,
so you need to treat each case as an individual. Be sure to minimize
anti-inflammatory medications. It is worth scrutinizing your program,
because even after “completely healing ulcers”, they
can and recur within 72 hours if the underlying problems are not
addressed.
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Question: What is ESWT?
Answer: ESWT stands for Extracorporial Shock Wave
Therapy. ESWT has been shown to dramatically enhance the rate of
soft tissue and bone healing in both people and now horses. Dr.
Revenaugh is a pioneer in this treatment and has answers these questions
from the experience of treating over 600 horses over the past 4
years with this method.
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Question: What are Shockwaves?
Answer: Shockwaves are strong positive pressure
acoustic waves. These waves transmit energy thru the skin into deeper
tissues where the energy is “released”. In order to
understand the concept, one might compare a jackhammer to a shockwave
unit. However, the energy wave of the shockwave has very unique
characteristics and is extremely fine-tuned in order to achieve
the desired physiologic response. In fact, the shockwaves are actually
focused to various depths and energy-levels depending on what injury
is being treated.
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Question: How are shockwaves
used in human medicine?
Answer: The first shockwave units were used for
pulverizing kidney stones in people, (lithotrypsy). A lot of excitement
was generated because, by using such a device, kidney stones were
cured without ever “breaking the skin”. These devices
are still widely used today for this purpose.
More recently, shockwave units have been used for treatment of a
variety of orthopedic injuries in people. Specifically, ESWT has
been used to successfully treat frustrating injuries such as: “tennis
elbow”, “Heel Spurs/ plantar fascistic”, as well
as calcifying tendonitis and delayed union, (non-healing), fractures
and other injuries.
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Question: Which horse injuries
respond to ESWT?
Answer: ESWT appears to stimulate tissue healing
in a broad variety of tissues. As mentioned above, most bone injuries,
(fractures, insert ional injuries, etc.) will potentially respond
to ESWT. For example, favorable responses have been seen after treatment
of bucked shins, splint-bone injuries, sesamoid-bone injuries and
high-suspensory disease to name a few.
Similarly, some horses with “ringbone”, lower hock joint
arthritis, and navicular disease have also responded dramatically.
Unfortunately, because of the multifactorial nature of these problems,
predicting which horses will respond can be challenging. It is important
to recognize that not all horses respond. In a retrospective study
presented at the annual American Association of Equine Sports Medicine
meeting this year, we calculated that approximately 10% of the 45
horses treated for high-suspensory disease did not respond.
ESWT is also used widely for treatment of a variety of soft tissue
injuries including: tendonitis, suspensory ligament injuries and
check ligament injuries. In acute, (new), injuries a lower energy
level is used, whereas older injuries require more energy to achieve
the desired response. In many cases, dramatic results are seen.
Horses with neck, back and pelvic injuries have also been treated
with favorable results.
It is also important to emphasize that in order to have a successful
outcome, one must first have an accurate diagnosis of the problem.
Once the diagnosis is made, the shockwave machine can be applied
to the identified area.
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Question: What is the treatment
protocol of ESWT?
Answer: ESWT is usually done one an outpatient
basis. The horse is brought to the clinic where he/she is sedated
before treatment. Many horses also require application of a twitch.
Treatment lasts approximately 5-15 minutes. When the sedation has
worn off, the horse can ship home.
Treatment protocols vary depending upon the specific injury. Anywhere
from 1-4 treatment sessions are conducted. If more than one treatment
is conducted, the treatments are ideally spaced at least 14 days
apart. Price also varies, depending upon how many “shocks”
are administered. One can expect to pay anywhere from $300 to $600
per treatment of a horse, (a recent newspaper article quoted between
$2,500-$7000 for the same treatment on people!)
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Question: What are the negative
side effects of ESWT?
Answer: When treated with appropriate dosages,
mild soft tissue swelling occasionally occurs. Such swelling is
mild, and is gone within 48 hours. No other negative side effects
have been identified. One of the best aspects of ESWT is that we
are oftentimes able to make a dramatic change in the healing/remodeling
process without ever breaking the skin. Very few medical therapeutic
modalities operate with this level of safety.
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Question: How does
Dr. Revenaugh feel about ESWT?
Answer: The use of ESWT on equine orthopedic injuries
is still in its infancy at this time. Because of the cost, ESWT
is usually used after traditional therapies have failed. We are
finding favorable results with ESWT, even on many otherwise frustrating
cases. After treating over 600 horses over the past 4 years and
watching the responses, it appears that we are only beginning to
realize the full potential of ESWT.
ESWT does not fix everything. Furthermore, a small number of cases
that “should,” respond don’t respond. Hopefully,
as we learn more, we will be more able to determine which cases
do and do not respond.
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