Echo's Vet Update

Before I dive into the latest installment of Echo's vet addiction, I do want to send out my best to all of you.  I went back & forth, but decided that I wasn't going to write much, if anything, about The Virus -- it was already all the words on all the channels & I didn't think I had anything meaningful to add to all that noise.  The best any of us can do at present is to follow reputable safety protocols to the best of our ability & for your own sanity, turn off the news & the facebook (if you even watch it, I do not anyway as I don't need to add to my sources of anger).

We are fine (at least as much as we ever are) here -- my job is secure & I can do much of my office work remotely to the extent that my limited rural internet access allows.  Our field work is reduced, but we will still be working on mission-critical projects; there is plenty of room for social distancing in the river though.  I generally don't go many places outside of work anyway; I hate grocery shopping so much I only go maybe once a month (basically when there is literally nothing left in the house), & as an introvert, I don't encounter other humans often.  I remain grateful to have the horses at home, so not many changes for us.  I definitely feel for all of you who can't see your horses right now & am hoping that ends as soon as possible! 

If you are in a position to help others, but are not sure what to do, you can follow this link to a summary page from Charity Navigator of groups which are accepting donations to help with everything from medical supplies to food to financial assistance.  Sending even a dollar from your living room is risk-free for you & can make a difference to someone else.

Click to find a reputable charity helping those in need

Turning back to my problem child...

Earlier this week, I took Echo back to the vet, as his shoulder was just...lingering.  I had started doing stretches & massage about a week prior to that following a phone consultation with vet.  That treatment did bring about some improvement & Echo was moving a bit more freely with a little less limping, but I wasn't comfortable proceeding without a better idea of what exactly we were dealing with.

Also..."Echo's Vet Update" should probably be the new name of this blog.

Turns out he did indeed partially tear his triceps muscle.  Good news:  that muscle is enormous, covering the entire scapula, so there is plenty of "extra" to do the job it needs to do.  Also good news:  it will heal without any functional limitations.  Also good news:  he is at the point in healing where he can start to go back to work as he needs to use it to continue making progress.

Equine shoulder; From horsesidevetguide.com

Less good news:  muscles heal slowly & giant muscles heal even slower.  It will probably 5-6 months until it is completely healed.  He may have a permanent divot to add to his existing scar collection, but at least it won't affect anything.

In the balance, while it's not great, it could be so much worse.  At least we can start doing things again, while is a huge relief to us both.  I will, as always, be conservative -- I got on a couple days ago & we just did walk work & stepping over poles.  Of course, Echo is already happily trotting & cantering around in the pastures on his own.  I'll never know exactly what happened -- maybe it was a kick, maybe he just slipped, maybe it was both.

His lump 10 days ago

I did put him back on the Equioxx, carefully, after we finished other meds, & am relieved that he is having no issues with it, so he has that mild anti-inflammatory support as we work through the physical therapy process.  He also completed a week of Ulcerguard & his stomach is much happier, so he's back to eating his meals (although still at the slowest....speed.....possible).

Farrier also put the hoof testers on him last week & he had no reactions, so it looks like the coffin bone bruise is healed up too.  At least it helps me to gauge lameness without the compounding factor of that foot on the same leg as his shoulder.

I'm sure Echo will find new things to do, but it still felt good to cross at least a couple of the more recent issues off the list.  And even though I hate any injury in my horses, it's going to happen one way or another, because horses, so I'm still grateful when it is at least something that will heal, because I've dealt with enough things that won't & that is much worse.

Shaking off gnats while regaining weight, shine, & getting less lumpy every day

Baby steps for Baby Monster, but we will begin re-building that topline once again.  It should be easier this time since he has more skills than he did a year ago - some of them are even useful.

Read More

Bute Vs. Equioxx: Tradeoffs

Because it's a good time to learn about things, right?

I recently had the unfortunate but useful opportunity to compare the results of the two most commonly used equine NSAIDs (Non-Steroidal Anti-Inflammatory Drugs; bute & Equioxx) on the same injury -- Echo's shoulder.  There are pros & cons to each.  Because I firmly believe in making the most informed decisions possible, let me share with you what I learned.

Background

Heat, pain, & swelling are the result of the body's inflammatory cycle.  One of the primary mediators of this cycle is a group of prostaglandins created by cyclooxygenase (COX) enzymes, which convert a substance interestingly named arachidonic acid (does it have spiders in it?).  There are different varieties in this group, referred to by number:  horses have COX-1 & COX-2, while humans have additional variants.  NSAIDs aim to break the inflammatory cycle by inhibiting the production of these enzymes, during which the body can break down harmful prostaglandins which have already formed (which takes about 12 hrs).

As you might suspect, COX-1 & COX-2 have different functions.  COX-1 plays important roles in things like maintaining stomach mucous coatings, keeping blood flowing through kidneys, & coagulating blood.  COX-2 is only found at low levels in normal tissues, but levels surge when that inflammatory process begins & COX-2 feeds that cycle. 

A simplified illustration from previcox.com; click to embiggen

Drugs

Bute refers to phenylbutazone, our old friend which has been around for decades.  It's cheap & fairly effective for pain management.  Given orally, it takes about 2-3 hrs to absorb from the belly & peaks in 3-5 hrs.  Persisting about 12 hrs, bute blocks both COX-1 & 2 production.

Equioxx is a brand name of firocoxib, a newer drug that is known in the canine world as Previcox.  It was developed for the treatment of osteoarthritis.  It's also given orally by owners, but is much slower to take effect.  It takes at least 24 hrs for levels to begin to peak & does not reach steady state for 4-6 days.  It also has a half-life of 44-46 hrs, so it takes an additional two days minimum to disappear after you stop giving it.  Firocoxib is a selective COX-2 inhibitor, which means it preferentially blocks COX-2 but still has a minor effect on COX-1.

Choices & My Observations

It just so happened that I was able to directly compare the two as Echo was on bute for the first week of his shoulder pain, then on Equioxx for a second week.  Pros & cons:

Bute Pros:

• Much more effective pain control (side note: I've heard the same from others)
• Significantly more rapid action - both to start & finish.  The latter can be especially important if you need to take a lame horse to the vet the next morning & you need the pain unmasked for an exam.
• Relatively cheap
• Easy to give -- even picky Solo will usually eat it on his food.  If they start refusing it after multiple days, I just dump it in a syringe with a little water & shoot it in their mouth.

Bute Cons:

• Blocking both COX-1 & 2 is what brings about the higher incidence of GI issues with bute.  This is why I switched to Equioxx, as Echo had already been on bute a lot for his foot bruise & I was beginning to see ulcer signs.

Equioxx Pros:

• Primary benefit is its selective COX-2 action:  this spares the GI tract some abuse, as well as protecting other COX-1 processes (cartilage maintenance is another one not mentioned above).
• Also pretty easy to give as a tablet -- Echo snarfed it up when I put it in my hand with a little grain.  I've also heard of people stuffing them in cookies or gumdrops.  Just don't let other humans eat the gumdrops.  I've also heard of that happening once, LOL.

Equioxx Cons:

• I saw significantly less pain control that definitely seemed better suited to something milder like arthritis.
• Slow action, both to kick in & withdraw.  
• Not cheap -- I did find (too late for me) that it was significantly cheaper online than through my vet.  Vet also did say that he did the math & it was actually cheaper per hour of pain control than bute was.  I believe him, but almost $2 a pill still hurts me.

Related note:  Equioxx & Previcox are both firocoxib.  Because Previcox can be cheaper, many people use it for their horses & just divide pills themselves.  However, be aware, it is now illegal, through the FDA, for a vet to give Previcox for a horse.  This is because accurate dosage for firocoxib is important to avoid adverse effects & it's very easy to over- or under-dose when manually dividing dog tablets.  This legal change occurred around 2016, when the tablet form of Equioxx became available; here is a good explanation.  I'm not going to call the drug police on you, just informing. 

One more note:  I learned from the Equioxx package insert that all NSAIDs have the potential to also block the prostaglandins which control body temperature.  This isn't common, but is something to keep an eye on if something goes awry.

Take Homes

Just like pretty much all of life, there are tradeoffs with each option, but I hope this will help you better understand which might work best for you.  I still consider bute my first line tool in acute pain control due to its strength & speed.  However, if you need to give an NSAID for a long period of time or are treating a horse who already has ulcers, Equioxx may be a more appropriate choice to protect GI tracts.

If you really want to dig in, here is a really nice paper from the Journal of the American Vet Med Association from 2017 on the COX enzymes & use of selective COX-2 inhibitors.

Read More