What is OCD?

Osteochondritis dissecans (OCD) is known as failure of bone underlying the smooth articular cartilage inside the joints to form correctly from the cartilage template of the skeleton. This weakness may result in cracking within the articular cartilage when the young horse takes weight on its joints during exercise.

Cartilage flaps and fragments consequently form within the joint and chemicals that cause joint inflammation (synovitis) are released. The affected joints may become visibly enlarged and distended with fluid which may lead to a lame horse.

Most commonly affected places:

Stifle, hock and fetlock.

Symptoms

There may or may not be lameness with a swollen, fluid filled joint (synovial effusion). Exacerbated lameness following flexion and painful to palpation of the joint.

Diagnosis

Commonly diagnosed with radiographs. Scintigraphy (nuclear bone scan) or arthroscopy (key hole surgery to look around) may be required if lesions are not visible on x-ray.

Treatment

Polysulphated glycosaminoglycans or hyaluronic acid injections administered either intramuscularly or into the affected joint, to reduce the inflammation. This is combined with box rest and adjustment of the diet.
Keyhole surgery may be required to remove cartilage and bone fragments from the joint, trimming (curettage) of frayed articular cartilage and flushing out chemicals that cause inflammation from the joint.

*** Copper deficiency linked to OCD***

You may of heard that copper deficiency may be linked to OCD in horses. Well here is an explanation as to how this may be the case by looking at some science behind it….

Within normal cartilage, collagen is made from single collagen polypeptide chains, into fibrils, and then finally into fibers. An enzyme called lysyl oxidase is responsible for the removal of a amino group from the fibril, thus making it highly reactive and allowing it to form covalent bonds with other fibrils via cross linking and ultimately forming bundles of fibrils known as fibers. Copper acts as a cofactor (helper enzyme) at the active site for this reaction to occur. Thus, without copper, the reaction will be much slower and the cross linking will occur less, leading to less collagen fibers and ultimately, weaker cartilage.

Other factors such as overfeeding and genetics have also been shown to play a part in OCD which we will look at in future articles.

Related articles;

N. Loving. Copper and OCD

Arthritis is one of the most common causes of lameness in the horse (Posnikoff, 2010). We have all heard of arthritis, but do we know what is happening at a cellular level?

Here are a couple of facts to help you understand some of the components that make up your horses joints:

Articular cartilage

A type of hyaline cartilage but has NO perichondrium.

****The perichondrium is a layer of thick connective tissue that covers the end of bones, EXCEPT on the articular surface of joints. It houses lots of progenitor cells (the precursors of cartilage cells – chondroblasts and chondrocytes). It is essential for the growth and maintenance of cartilage*****

Glycosaminoglycans

Sulphated: Chondroitin 6-sulphate, chondroitin 4-sulphate, Keratan sulphate (what you are paying for in your joint supplements). These predominate in the matrix and form a high density of negative charges which attract sodium…. the sodium attracts water (water follows salt), and you end up with cartilage consisting of 75% water.

Non-sulphated: Hylaronic acid – This forms the backbone of the whole complex.

Synovial fluid

A viscous fluid found in the joint capsule, made up of hyaluronic acid and lubricin, proteinases, and collagenases

What do the images above tell us?

The top left shows us what normal articular cartilage should look like. The particular stain used in this slide stains for Glycosaminoglycans (GAGs). This shows up as a deep red colour and as you can see, there is plenty of it. This is healthy articular cartilage.

The middle image is in the early stage of arthritis. As you can see, the surface of the joint is beginning to lose some of that red staining. This shows us that the number of GAGs is starting to reduce. With a lower number of these GAGs, the water content of the cartilage starts to reduce… the cells begin to die, and the cycle of chondrocyte death continues.

The final image on the right demonstrates severe arthritis and may arise if the condition is left untreated.

What can we do to prevent this from happening to our horses?

Once arthritis has set in, we cannot reverse it. We have already mentioned that the joint surfaces do not have perichondrium, hence are unable to provide extra cartilage cells required to replace the ones that have died. We can only try and slow down the process.

One method is to use cortisone (steroids), administered via intra articular injection. However, there are both positives and negatives for doing so;

Positive: It will calm down inflammation within the joint, thus reducing the amount of watery inflammatory fluid, and helping to return the synovial fluid to a correct, more viscous consistency.

Negative: Cortisone suppresses Add to dictionary GAGs. Remember these have negative charges, attracting sodium, and thus water…. without these the joint capsule dries up, cells die and the degeneration cycle continues.

However, a synthetic,  high molecular weight hyaluronic acid, such as SynVet-50 (we use this in practice, however there are also others available on the market), has been carefully developed to provide lubrication for these compromised articular surfaces. It can be used alone, or combined with cortisone (the two combined have been proven to work synergistically, as the hyaluronic acid acts as a synthetic synovial fluid to prevent the capsule from drying up), to slow down or arrest the progression of the disease, thus providing a brilliant mode of treatment.

If you would like any advice on the prevention/treatment of arthritis, including non invasive methods such as supplementation, why not give one of our vets a call who will be happy to assist.

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Temporomadibular joint  (TMJ) 

Understanding the function of this joint is very important in maintaining your horse’s comfort and peak performance!

What/where is it??

• Articulation between the condylar process of the mandible and the zygomatic process of the  temporal bone.
•  The joint surfaces are formed by the dorsal process of the ramus of the mandible, the mandibular fossa of the skull, and the condylar surface.
• The whole joint is supported by fibrous lateral and elastic caudal ligaments.

http://porta-grazer.com/testimonials-2/

http://www.atlantaequine.com/pages/client_lib_tmj.html

What does it do?

• Mastication or the grinding of food – relies heavily on lateral excursion to break down grasses and feeds.
• Part of the larger Stomatognathic System, which includes the shoulder girdle and all structures above it.  An abnormal gait may actually cause abnormalities in the bite occlusion, and malocclusion (misalignment of teeth) may lead to changes in posture or gait!
• Proprioception (knowing where we are in space) device when vision cannot be relied upon.

What can go wrong?

• Sepsis of the joint or luxation (dislocation) or subluxation (partial dislocation) of the joint caused by trauma.
• Septic arthritis of the joint – usually associated with trauma.
•  Non-septic arthritis of the TMJ – associated with dental disease.

Clinical signs

• Pain during manipulation of the mandible (lower jaw) or palpation of the joint.
• Atrophy (wasting away) of one or both masseter muscles (cheek muscles).
• Actual bony enlargement of the region of the TMJ.
• Abnormalities in chewing, including restricted range of motion in the mandible
• ********** ABNORMAL BEHAVIOUR, SUCH AS ABNORMAL HEAD CARRAIGE, HEAD SHAKING, BITTING PROBLEMS*******

Treatment

• Septic joint: Administration of antimicrobial drugs alone or coupled with surgical excision of septic tissue.
• Luxation of the joint: Successfully corrected, by placing a metal mouth gag between the molars on the side of the dislocated TMJ, while the horse was anaesthetized, and  pressure applied to the rostral portion of the maxillae and mandible to close the mouth.
• Non-septic arthritis: Injecting corticosteroid with a high molecular weight hyaluronic acid (SynVet-50), into an arthritic TMJ.
• *** Get any dental issues checked and resolved***

Source: http://www.ivis.org/proceedings/aaepfocus/2006/schumacher2.pdf

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The most commonly reported neoplastic lesions in the horse are sarcoids.

Treatments include various topical applications, immunotherapy, chemotherapy, radiation therapy, cryosurgery, traditional ‘sharp’ surgery, and laser surgery.

** No single treatment has been shown to be suitable for all sarcoids in all locations. **

Today we are looking at laser surgery, as the team at Nantwich Veterinary Group are now offering this fantastic service.

How does laser surgery work?

The heat contained in the beam of the laser has the unique ability of vapourising the neoplastic cells, in turn, generating an area of irreversible necrosis around the margin of the surgical site, and an additional zone of oedema and inflammation.

The advantage of this treatment is the limitation of ‘seeding’ from the site due to the desquamation of cells from the lesion surface or its cut roots.

Further advantages include;

• Usually bloodless
• Reduced hemorrhage, swelling and importantly pain
• Sterilisation of the surgical site
• Shorter hospitalisation time

Scientific research

A study carried out by Compston et al., 2015 evaluated the effects of laser surgery in 99 horses with a total of 235 sarcoids.

Interestingly 83% had no occurrence of the sarcoid removed and 72% had no occurrence of the sarcoids following surgery.

IMPRESSIVE!

If you have a horse with sarcoids, this is an extremely promising treatment and the results speak for themselves!

References

Compston, P. Turner, T. Wylie, C. Payne, R. Laser surgery as a treatment for histologically confirmed sarcoids in the horse. 2016. Equine Veterinary Journal. pp. 451-456.

Well the time has finally arrived…. and I am almost towards the end of my first week as a fully fledged veterinary student at the Royal (dick) School of Veterinary Studies up in Edinburgh.

I must firstly apologise to my friends and family for the lack of communication since I arrived… its been a little bit hectic!

I cannot begin to tell you how excited I am!! As I sat through the first introductory lecture with the Royal (dick) School logo imprinted on the wall, I remembered how I felt during my interview back in January. To be honest, I never thought for one minute I would be back a few months later to study…. but miracles happen : )

The highlight of my week has to be getting my veterinary student name badge. Honestly, I think I was the fastest one in the room to attach it to my shirt!

It stays on the unit next to my bed so it is the first thing that I see when I wake up!

I also managed to take some photos of the clinical room where we learn the skills needed to prepare ourselves to eventually take care of your cat/dog/horse etc. And this did not disappoint…..

Now I have never seen anything quite like it. Understandably, I’m sure you will agree that it is like a Hogwarts for vet students!

Most importantly, the vet school is allowing me to use these photos, and future photos on social media, which will hopefully encourage you to follow my journey as the most excited vet student ever.

Speak soon, Emily xxx

Median length of remission (decrease or disappearance of signs) was five months by February 2016, mean ten months, remission ongoing in nine horses). Remission of at least two months duration was obtained in 14.41 horses (34%).

*** One third of cases were successful. ***

What does this tell us?
A larger subject size gives us more promising evidence that the PENS is useful at reducing/eliminating symptoms in horses that headshake. However, it is likely that this procedure will need repeating as little as every two months (so please consider next years insurance), however research into the effects of prolonged and repeated treatment is unknown.

Interestingly, I managed to have a chat with the leader in headshaking research, Dr. Derek Knottenbelt. He is currently trialing the Shakeaze muzzle guard with headshaking patients and was enthusiastic and positive about the nature and design of this new product. He also agreed that headshaking may be a degeneration of the central nervous system, and not just the trigeminal nerve and although there are products that can alleviate some of the symptoms i.e. nose nets and masks, we are still no closer to a definitive cure for this condition.

Another lecture on headshaking is scheduled for tomorrow by veterinarian, Vikki Scott. She has been in touch to ask permission to mention the Shakeaze guard in her presentation, and it will be very interesting to hear her thoughts on why it has been so successful in numerous cases.

Useful links;

https://www.facebook.com/shakeaze/?ref=aymt_homepage_panel

2016 has been one of the worst years for overweight horses/ponies due to the warm winter we have had. Horses are designed to store fat over the summer and lose it over the winter. However, due to the lack of frost, followed by warm, wet weather, a large proportion of horses have entered the spring/summer already far too heavy. This has become apparent with the higher percentage of laminitis cases, and NOT just your typical natives.

Having a good doer myself, I know how difficult it can be to shed those pounds, therefore I have devised a list of top tips suggested by veterinarians and clients to help you along the way : )

1.       Keep a bucket of hay outside the stable. This works well if you have your horses at home/busy yard. Every time your passing throw him a handful over. He won’t be going for hours on end after guzzling his pony sized haynet and your worries of him developing ulcers can subside as his stomach will not be spending hours without forage.

2.       Some people think limiting grazing to an hour per day will help. It won’t, especially when the horse is on strict hay rations. The horse will be hungrier and eat more. Ever opened a bar of chocolate when your hungry?

3.       Grazing muzzle. Good if used strategically. Try not to have a few hours with it on and then whip it off to let them have an ‘all you can eat’ grass buffet. Same reason as number 2. Studies have shown horses to eat their whole daily allowance in an hour after having a grazing muzzle removed. Therefore if you are using them, use them permanently whist your horse is in the paddock.

4.       Double your haynets. It will take longer to snaffle through and stop you from stressing that poor Bertie is bored.

5.       Look at these photos. If you don’t understand the term ‘cruel to be kind’, you do now.

Clockwise top left: horsevm.com, horsevm.com, roodandriddle.com, hoofcare.blogspot.ca

6.       Horsey weight watchers. Have a set time every week to weigh your horse, either using a weigh bridge or a weigh tape. The horse’s weight can fluctuate throughout the day so make sure you stick to that set time. If there are a few of you in one yard it’s always good to get some competitive spirit and play for a weekly prize; the winner being the owner with the biggest weight loss (horse not owner!). But play with your horse’s best interests at heart… I know us equestrian folk can get ruthless in competition ; ).

7.       Soak your hay overnight. This will leach out any goodness…. Significantly reducing calories.

8.       Feed a vitamin and mineral supplement, especially if you are soaking your hay, or if it is of poor quality.

9.       Exercise. Exercise. Exercise. Muscle uses more calories than fat. This will ensure that the weight comes off quicker and stays off for longer.

10.   Condition score. It takes a couple of minutes to condition score your steed and is completely free!!

11.   No excuses. Your horse is fat because it eats too much and is not doing enough exercise. Yes, some are more difficult than others but it just means you have to work harder. The average horse can safely lose 1% of its body weight per week without dying from lack of food.

When you think that 90% of lameness problems are foot related, do you really need that extra weight on an already too small, delicate structure? Please try some of these tips. I helped kill my previous horse with kindness by allowing him to get laminitis from overfeeding, don’t let it happen to you.

Nantwich Equine Vets are supporting this initiative by offering free use of their weigh bridge mon-fri, by appointment only. Please feel free to give us a call and book in : )

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How many of us know when their horse is lame? Unless you see lame horses on a daily basis it can be extremely difficult to spot, as identifying lameness is a skill that can only be fully developed by years of repeated observation, hence why getting a good lameness vet is a God-send. However, as horse owners there are several things you can try to look out for that I have written below in my ‘Ten top tips on how to spot lameness’. I’m not saying diagnose your own horses but it can help you save both your horses longevity and your hard earned cash in the long run if you spot any problems early on. Its also useful for those that are rehabilitating their horses at home, in helping to spot any early signs of deterioration.

1. Trot him away from you in a straight line. Are his quarters level? Does the right side drop more than the left?… If it does you may have a right hind lameness as he moves his lame leg through a greater range of motion to reduce the stress of loading.
2. Trot him towards you in a straight line. Does his head nod when one forelimb hits the ground? If it is only when the right forelimb makes ground contact, you may have a left forelimb lameness (when the lame leg hits the floor, it hurts and the head is raised, then as the weight is transferred to the sound limb, the horse is more comfortable and the head is dropped). Whereas if the head nods when the left forelimb makes ground contact, you may have a right forelimb lameness. Vets look for the nod as its easier to see than when the head is raised, although this can confuse some people at first, its just the way it is.
3. Watch the horse from the side as he trots past. Is he tracking up equally with both hinds?
4. Get your lunge line out and put him on a circle. Lameness is easier to see on a circle and make sure you go in both directions. A hard surface such as the car park will provide more concussion therefore will help show up any lameness within joints. A soft surface such as the arena will provide more give, stretching the tendons and ligaments and will show up any soft tissue lameness.
5. Check for a pulse at the level of the fetlock and compare between limbs. An increased pulse may indicate signs of inflammation.
6. Check for heat in the feet. This can indicate inflammation within the hoof capsule such as laminitis.
7. See the horse with a rider on board. So many horses show up sound on the lunge but are dramatically lame when carrying the extra weight. Additionally, saddle slip has been scientifically proven to be a result of hind limb lameness in a large number of cases.
8. Check your horses back. Apply firm pressure along the muscles either side of the spine. Does he react? Back tenderness can be secondary to lameness i.e. holding the muscles to compensate for limb lameness and thus resulting in a ‘bad back’.
9. Video analysis. I’m not talking the expensive kind, a mobile app! I downloaded the Speed Pro video app on my iPhone which enables me to slow videos of the horses right down. Lameness is always easier to see in slow motion!
10. KNOW YOUR HORSE. This cannot be stressed enough. These checks can be carried out on the sound horse to allow you to make comparisons when something is not quite right i.e. Does he always react to his back muscles palpated? Are his feet always a little warm? Is he always forward going and suddenly he is not? Has he always been lame whilst lunged on the concrete ? – after all how many of us has ever lunged on concrete?

*** With regards to the Speed Pro app for the iPhone, please follow this link to see how it can be used as a great tool for evaluating lameness. Note the horse is lame right fore, therefore the ‘nod’ is visible as the left fore hits the ground.

A big thank you to this horses owner for allowing us to publish this video.

Lameness right-fore

I wanted to touch on how the horses back is affected by everything that is going on in the limbs.

I heard this great saying recently;

“Quit fixing the roof when the problems are in the basement”.

(Ray Thomas- SynVet 50) http://www.synvet.eu/

This is true. The amount of clients that arrive at Nantwich Veterinary Group Equine Centre are under the assumption that their horse has a back problem. Following investigation, over 95% of those horses will have an underlying lameness.

The horse has learned to adapt to this lameness by transferring more weight across to the other limb which in-turn will affect the way the back muscles relax and contact. This is a sure easy way to create those ‘muscle spasms’ and low and behold the horse has a ‘bad back’.

It is not only important to relieve these spasms as a consequence of lameness but only once this lameness has been treated, otherwise you will be back to square one within a week or two. We regularly advise physiotherapy/sports massage/pole work/carrot stretches for horses recovering from lameness to correct any back soreness created along the way.

Additionally it is not only us at Nantwich that have reached this conclusion… Several scientific studies have proven that the equine back is affected by lameness, including the famous ‘saddle slip’ study by the famous Sue Dyson, that demonstrated a whopping 54% of horses with saddle slip presented with hindlimb lameness.

Click to access Conference%202014%20Sue%20Dyson%20Abstracts.pdf

So how can a supple back indicate any early signs of lameness?

Now this is the important part;

PREVENTION IS ALWAYS BETTER THAN CURE!

As discussed, many horses present with a sore back secondary to lameness issues and it is the sore back that owners seem to notice first. Additionally, it is always the horses with suppler backs that present a higher degree of reactivity when the back is manipulated. Therefore, if owners maintain suppleness in their horses back muscles, the early signs of problems arising from the feet will be easier to spot and gives you the best chance of fixing a small problem before it escalates into a much bigger one.

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Considering spring is upon us and the 2016 show season has started I thought I’d touch upon the subject that is discussed, year after year.

And yes you’ve guessed it…. laminitis.

I am not solely pointing the finger at the showing world, however unfortunately, this is where I am seeing the grossly overweight horses/ponies once again. Additionally, every internet forum that I have recently stumbled across are us ‘horsey people’ asking for advice on how to put weight on our steeds.

I am not perfect, not by a long stretch and have learnt the hard way.  The images above are of my late horse and taken less than two months apart. Yes two months!

The black area at the toe is a gas shadow, as a consequence of the lamellae being torn apart and rotation of the pedal bone is clearly visible. The two dark ridges near the coronary band show the depth of the lamellae death and is what you would see as ‘laminitic rings’ on the outer hoof wall.

People think that once a horse has recovered from a laminitic episode, all is ok. It is not. The anatomy has changed and WILL NOT return to the way it was. Changing the angle of P3 does not just alter the hoof-pastern axis, it alters the structures above it. Following twelve months of corrective farriery and veterinary treatment, from the outside my horses foot looked normal. However, the tip of the pedal bone was now predisposed to bruising and he was also diagnosed with a suspensory lesion.

How is the suspensory ligament injury linked?

***** When P3 is rotated, pressure is taken of the deep digital flexor tendon (DDFT) (the tendon that runs over the back of P3), which is why shoes with ‘wedges’ are recommended for DDFT problems. However, to take the pressure off the DDFT, that pressure must be transferred to another structure….The Suspensory ligament. This has been recorded in several scientific studies, and my horse was a text book example *****

The long and short of it is I KILLED MY HORSE.

I killed him with kindness, and even worse I killed him to win show classes. I took the advice from show judges; “get more weight on him”, “he will look small in the county classes”, “feed four times daily and get him on lush grass”.

If I had known then what I know now he would still be here.

I think the issue needs to be, once again, addressed. People are quick to jump up shouting and screaming at the racing industry with regards to welfare , but I am yet to see a racehorse ‘falling out of its feet’.