Injections, that is.
I wanted to talk a little bit more about what steroid injections do, about where the science is today, & about what my experience has been within my sample size of n = 3. Full geek-out links are included for your reading pleasure.
Yes, I used to be one of those people who said you should never puncture a joint capsule & introduce bacteria unless your horse was at death's door & blah blah blah. I fully admit my lack of education on the topic & can gladly say that time, careful research & thought, & experience has changed my position somewhat.
While I still don't believe in administering "preventative" joint treatment, I have learned that, in a problem area, steroid injection can be a very powerful tool to keep your horse doing his job happy & comfortably over the years.
Why would I want to inject my horse's joints?
Most sporthorses (and humans, sigh) will experience a deterioration/roughening of their joint surfaces & sometimes a reduced production of synovial fluid (joint lube). The results can vary from just a little extra warm up time to reduced range of motion & pain.
Sometimes that can be treated with a reputable feed-through supplement (I have gotten good results with SmartFlex Senior) or an intramuscular injection which addresses the body as a whole, such as Adequan. These can increase production of synovial fluid & even help repair cartilage.
However, sport is demanding on both our bodies & sometimes we need targeted relief. Arthritis is technically defined as joint inflammation, which causes the pain, & if you don't break that cycle of inflammation, the body will compensate, causing problems in other areas & the horse (or person, ow) will continue to degrade in condition. So the key is breaking that cycle at the source.
What do they shoot in there with those big, fat needles?
The fluid injected is generally a mix of broad-spectrum antibiotics to prevent infection mixed with a corticosteroid. For example, my own spinal injections were done with dexamethasone. Encore's were triamcinolone. If I remember correctly, Solo's hocks got cortisone. All are the same type of drug & reduce the inflammation in the joint.
You can also include hyaluronic acid if you'd like to drop another $300 per injection, however, Dr. Bob says he sees little difference unless you are competing at the very top levels of your sport, i.e. if you are the 1%.
That sounds expensive. Oh wait, it's a horse.
It can feel expensive. A set of hock injections (doing both high & low hock joints) here will be $300. That breaks down to $50 per month. The cheapest I have found Adequan is $36 per dose & I used that approximately once a month, so the prices are not far off & the IA (intra-articular, or in the joint) injections were effective immediately & worked better. A back or SI injection may range from $350-500.
Try to think in the long term & make fair comparisons. That feed-through supplement may sound cheaper, but it may be costing you $40 a month & results may be something you can feel maybe if you close one eye & hold your tongue just right. So it's all relative & in the grand scheme of a horse's career, it may not be as expensive as you think.
What's the point if I just have to do it again later?
Each horse is unique & each joint is unique. Some horses can get one joint injection, the cycle is broken, & that joint will perform pain-free for the rest of their lives. Others do have to be repeated.
For example, to compete, Solo needed his hocks injected every six months (a fairly standard interval for horses with mild to moderate hock arthritis). But it is impossible to predict, because just like humans, the results will vary with each body.
But by breaking the joint capsule, am I not taking this huge risk of bacteria getting in there & killing my horse?
Every puncture of the skin can open a passageway for bacteria. A fly bite, a scratch, a shot, all create a chink in the armour. But any worthwhile vet should take every precaution to make sure your horse is safely injected.
As I mentioned before, antibiotics are usually included in the injection itself. The horse's skin is washed & scrubbed repeatedly to sterilize it. Often, the hair is clipped away to create a clearer work area. It should never be a procedure taken lightly or performed quickly.
How soon will I notice a difference?
Like every biological process (engineers hate talking to us), it depends. For Solo, within three days, he had power & loft back in his trot. For me, the first 3-4 days after the injections were intensely MORE painful, then over 7-10 days the pain decreased rapidly, although there was some bruising, & by 2-3 weeks, I felt pretty darn good That was a year & a half ago.
Encore is about 10 days post injection; he still has a sore spot or two if I hit it just right with the curry & if there are bone or connective tissue bruises as the vets suspected in the stifle or hock, those will take a few weeks to heal (yeah, I had those too last year, we REALLY match). There were some really promising moments in the trot on Saturday, but I am taking it slow & easy & demanding little. At three weeks, we will know more.
How do they know the needle is in the right spot?
Some injections, like hocks, stifles, & fetlocks, can be done by feel by an experienced vet. Others, like vertebrae or SI joints can be guided by radiograph or fluoroscope (live video radiograph) because the target is small & surrounded by large muscle groups.
I hear all these condition names thrown around with injections, what do they really mean?
Science is a continuum -- it is forever evolving & forever learning. Often, when something is not completely understood, vets toss it into a pre-existing bucket so that clients can have a label to hold on to.
Take "navicular" for example -- this is a convenient bucket that can contain all manner of arthritic & bony changes & inflammation to the navicular bone. Some are very serious & career ending, others simply require a change of hoof angle or shoe.
Another growing bucket is "kissing spine" -- this is the one Encore got tossed into. Right now, it is being used to contain cases where either arthritic changes or simply conformation or genetic misfortune cause the spaces between the vertebral processes to be narrower than normal. The degree & effect can range from zero to 15....on a scale of 1 to 10.
This may sound frustrating, but it's because we are still learning. But clients want a name, they want a definitive answer, heck, I want a definitive answer. Even though the name may not be a very accurate one, nor truly fit the original description of the condition.
I have come to really like a plain big ol' cut: I can see it. I know what's wrong. I know how to treat it. I can watch it heal. And I know when it's fixed.
This internal stuff, well, I'm kinda over it. Actually, I'm WAYYYYY over it. From a scientific perspective, it is fascinating. But I'd rather be fascinated by someone else's horse, thank you. However, I hope this treatise, which escaped me & ended up longer than intended, can help you understand a little bit more about the process & why steroid injections can actually be your friend.
Or in the case of my back, your true love.
I wanted to talk a little bit more about what steroid injections do, about where the science is today, & about what my experience has been within my sample size of n = 3. Full geek-out links are included for your reading pleasure.
Yes, I used to be one of those people who said you should never puncture a joint capsule & introduce bacteria unless your horse was at death's door & blah blah blah. I fully admit my lack of education on the topic & can gladly say that time, careful research & thought, & experience has changed my position somewhat.
While I still don't believe in administering "preventative" joint treatment, I have learned that, in a problem area, steroid injection can be a very powerful tool to keep your horse doing his job happy & comfortably over the years.
Why would I want to inject my horse's joints?
Sometimes that can be treated with a reputable feed-through supplement (I have gotten good results with SmartFlex Senior) or an intramuscular injection which addresses the body as a whole, such as Adequan. These can increase production of synovial fluid & even help repair cartilage.
However, sport is demanding on both our bodies & sometimes we need targeted relief. Arthritis is technically defined as joint inflammation, which causes the pain, & if you don't break that cycle of inflammation, the body will compensate, causing problems in other areas & the horse (or person, ow) will continue to degrade in condition. So the key is breaking that cycle at the source.
What do they shoot in there with those big, fat needles?
The fluid injected is generally a mix of broad-spectrum antibiotics to prevent infection mixed with a corticosteroid. For example, my own spinal injections were done with dexamethasone. Encore's were triamcinolone. If I remember correctly, Solo's hocks got cortisone. All are the same type of drug & reduce the inflammation in the joint.
You can also include hyaluronic acid if you'd like to drop another $300 per injection, however, Dr. Bob says he sees little difference unless you are competing at the very top levels of your sport, i.e. if you are the 1%.
It can feel expensive. A set of hock injections (doing both high & low hock joints) here will be $300. That breaks down to $50 per month. The cheapest I have found Adequan is $36 per dose & I used that approximately once a month, so the prices are not far off & the IA (intra-articular, or in the joint) injections were effective immediately & worked better. A back or SI injection may range from $350-500.
Try to think in the long term & make fair comparisons. That feed-through supplement may sound cheaper, but it may be costing you $40 a month & results may be something you can feel maybe if you close one eye & hold your tongue just right. So it's all relative & in the grand scheme of a horse's career, it may not be as expensive as you think.
What's the point if I just have to do it again later?
Each horse is unique & each joint is unique. Some horses can get one joint injection, the cycle is broken, & that joint will perform pain-free for the rest of their lives. Others do have to be repeated.
For example, to compete, Solo needed his hocks injected every six months (a fairly standard interval for horses with mild to moderate hock arthritis). But it is impossible to predict, because just like humans, the results will vary with each body.
 |
| I really want a full set of knitted bacteria... |
Every puncture of the skin can open a passageway for bacteria. A fly bite, a scratch, a shot, all create a chink in the armour. But any worthwhile vet should take every precaution to make sure your horse is safely injected.
As I mentioned before, antibiotics are usually included in the injection itself. The horse's skin is washed & scrubbed repeatedly to sterilize it. Often, the hair is clipped away to create a clearer work area. It should never be a procedure taken lightly or performed quickly.
How soon will I notice a difference?
Encore is about 10 days post injection; he still has a sore spot or two if I hit it just right with the curry & if there are bone or connective tissue bruises as the vets suspected in the stifle or hock, those will take a few weeks to heal (yeah, I had those too last year, we REALLY match). There were some really promising moments in the trot on Saturday, but I am taking it slow & easy & demanding little. At three weeks, we will know more.
How do they know the needle is in the right spot?
Some injections, like hocks, stifles, & fetlocks, can be done by feel by an experienced vet. Others, like vertebrae or SI joints can be guided by radiograph or fluoroscope (live video radiograph) because the target is small & surrounded by large muscle groups.
I hear all these condition names thrown around with injections, what do they really mean?
Science is a continuum -- it is forever evolving & forever learning. Often, when something is not completely understood, vets toss it into a pre-existing bucket so that clients can have a label to hold on to.
Take "navicular" for example -- this is a convenient bucket that can contain all manner of arthritic & bony changes & inflammation to the navicular bone. Some are very serious & career ending, others simply require a change of hoof angle or shoe.
Another growing bucket is "kissing spine" -- this is the one Encore got tossed into. Right now, it is being used to contain cases where either arthritic changes or simply conformation or genetic misfortune cause the spaces between the vertebral processes to be narrower than normal. The degree & effect can range from zero to 15....on a scale of 1 to 10.
This may sound frustrating, but it's because we are still learning. But clients want a name, they want a definitive answer, heck, I want a definitive answer. Even though the name may not be a very accurate one, nor truly fit the original description of the condition.
I have come to really like a plain big ol' cut: I can see it. I know what's wrong. I know how to treat it. I can watch it heal. And I know when it's fixed.
This internal stuff, well, I'm kinda over it. Actually, I'm WAYYYYY over it. From a scientific perspective, it is fascinating. But I'd rather be fascinated by someone else's horse, thank you. However, I hope this treatise, which escaped me & ended up longer than intended, can help you understand a little bit more about the process & why steroid injections can actually be your friend.
Or in the case of my back, your true love.
