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Expert
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Location: MI | for further diagnosis or treatment of strongly suspected hindlimb proximal suspensory desmitis, where would you spend it?
Today, after blocking the above the fetlock and below the hock, the vet is 90% certain it's PSD. I have the thread below where the symptoms started.
I realize that it's not much money to be able to spend, at all, I know. But to start treatment or further diagnosis? | |
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 Shelter Dog Lover
Posts: 10277
 
| My gelding had a 40% high tear in rear suspensory. I did PRP-$900, sweated with Runner's Relief (around $250 but lasts a long time) at night and iced twice a day with magnets between icing. He healed faster than any of their other PRP patients with same injury. I still gave him a year off to be safe. I attribute his excellent healing to the Runner's Relief sweat, that would be where I would spend my $$. It was explained to me that the suspensory does not have good blood flow so anything that can bring good flow and oxygen to the area is great for healing. I created a sweat my mixing a couple of scoops of the RR in a jar of phurazone. I put a baby diaper on it and used an ace bandage to wrap. I used the same bandage till it gave out- cheaper than vet wrap. Good luck. My guy was given less than 19% chance of ever running barrels again and he has been back for 3 years at 100%. | |
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Expert
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Location: MI | rodeomom3 - 2014-05-07 3:59 PM
My gelding had a 40% high tear in rear suspensory. I did PRP-$900, sweated with Runner's Relief (around $250 but lasts a long time) at night and iced twice a day with magnets between icing. He healed faster than any of their other PRP patients with same injury. I still gave him a year off to be safe. I attribute his excellent healing to the Runner's Relief sweat, that would be where I would spend my $$. It was explained to me that the suspensory does not have good blood flow so anything that can bring good flow and oxygen to the area is great for healing. I created a sweat my mixing a couple of scoops of the RR in a jar of phurazone. I put a baby diaper on it and used an ace bandage to wrap. I used the same bandage till it gave out- cheaper than vet wrap. Good luck. My guy was given less than 19% chance of ever running barrels again and he has been back for 3 years at 100%.
Thanks so much. What magnets did you use? I was looking at the RR, and thinking strongly about it. We certainly have enough baby diapers around here, lol. Do you think the baby diaper/ace bandage worked better than a standing wrap? Did you do this regimen for the full year? | |
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Shelter Dog Lover
Posts: 10277
| I used the PHT hock magnets. I did the sweats with RR for about 3 months. Standing wraps would work great. I liked the diapers because of the plastic wrap. | |
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Expert
Posts: 1543
Location: MI | Thank you, thank you. :) | |
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| I would put the $250 in my pocket and keep it there ....
There is no magic fix nor anything that will actually realistically make it heal quicker .... turn him out for 6-12 months ... TIME IS YOUR BEST FRIEND ....
Being able to walk and get the frog to pump blood up and down his leg is the best medicine money can't buy!! and do not wrap his leg and cut his blood flow off .....
Edited by BARRELHORSE USA 2014-05-08 12:38 AM
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The Advice Guru
Posts: 6419
| Ridenrun4745 - 2014-05-07 3:46 PM
for further diagnosis or treatment of strongly suspected hindlimb proximal suspensory desmitis, where would you spend it?
Today, after blocking the above the fetlock and below the hock, the vet is 90% certain it's PSD. I have the thread below where the symptoms started.
I realize that it's not much money to be able to spend, at all, I know. But to start treatment or further diagnosis?
I would X-ray and ultrasound to confirm. I need a definite diagnosis, and my vet needs to be able to prove it to me and show me the results. | |
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 Tough Patooty
Posts: 2615
Location: Sperry, OK | Ridenrun4745 - 2014-05-07 3:46 PM for further diagnosis or treatment of strongly suspected hindlimb proximal suspensory desmitis, where would you spend it? Today, after blocking the above the fetlock and below the hock, the vet is 90% certain it's PSD. I have the thread below where the symptoms started. I realize that it's not much money to be able to spend, at all, I know. But to start treatment or further diagnosis?
Can your vet not U/S to confirm diagnosis? | |
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 Veteran
Posts: 168
Location: Wyoming | I would spend a little of the money to ultrasound and make sure exactly what you are dealing with. Around here they run from $40 to $75 for ultrasound. I used Runners Relief and Nutrawound from T.H.E. My most recent was stall rest for 2 months and a rehab schedule, then turned out for the rest of winter. | |
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Expert
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Location: MI | I came home to think about it (I have the fuzziest pregnancy brain right now, I can not wait to be able to think logically again), research the options, etc. My vet had other appts showing up, I had to get my kids home and talk to my husband. I know that I'm going to see him again soon, and he said he can do ultrasound or X-ray at my place, so we decided to wait. Oh, and (most importantly) we waited on any US because of the blocking that we did, he didn't want to do ultrasound that day due to the excess fluid that might skew the clarity.
So my vet will do ultrasound, and/or X-rays for a better dx. He prefers X-rays to rule other joint issues or maybe a bone spur aggravating the suspensory out, he will do ultrasound but said that sometimes it's difficult to tell from an ultrasound.
I was reading some recent interviews and studies on PSD, and specifically one recent interview with a vet out of North Carolina State U where he was talking about diagnosing PSD. On Mel we did the blocks as this vet described, and she demonstrated better than a 70% improvement in lameness, which is what he said they expect if that region is the source of pain. The next question was about ultrasound vs MRI for a dx. To date they have ultra sounded and MRI'ed 23 horses and the US has shown 9 ‘true positive’ , 12 ‘false positive’, 1 ‘false negative’ and 1 ‘true negative’. It says "The positive predictive value of an ultrasonographic abnormality in the proximal part of the suspensory ligament was found to be as low as 43%."
So given our lameness exam and my mare's signs/symptoms and response to blocking, my vets thought on ultra sounding and the research that I've done, I am not so sure about ultrasound's ability to definitively diagnose and provide good, accurate information? I know some will say that it's better than nothing, but is it really if it is giving that many false positives also?
Edited by Ridenrun4745 2014-05-08 8:07 PM
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The Advice Guru
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| Of course your vet wants to make another appointment as he gets to charge his flat rate exam fee again, in my area it is 60 before a vet even looks at the horse.
I also believe that an X-ray and ultrasound are only as good as the vet taking them.
I also believe in a concrete diagnosis, as then you can decide treatment plan, prognosis, etc. | |
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Expert
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Location: MI | cheryl makofka - 2014-05-08 8:53 PM
Of course your vet wants to make another appointment as he gets to charge his flat rate exam fee again, in my area it is 60 before a vet even looks at the horse.
I also believe that an X-ray and ultrasound are only as good as the vet taking them.
I also believe in a concrete diagnosis, as then you can decide treatment plan, prognosis, etc.
I would agree with you on 'just wanting to charge me more money', but I've also read supporting evidence on his thought process of waiting on the ultrasound, and that the extra fluid from the blocking may impair the ultrasound results. Also, I don't think he will charge me another farm call. Honestly, he's an old friend, and I don't think he'd be out to take my money. I realize that could go both ways - that I'm just using him because he's an old friend and not a good lameness vet, but I am trying to research this smartly (and really, I really appreciate yours and everyone's thoughts on this, it helps!), and am definitely learning a lot along the way.
I agree with the x-ray and ultrasound and the vet's ability, definitely. I'm not a newbie to vet work, I worked in small animal emergency medicine for quite a while in college. I thought about that while reading the MRI/ultrasound study, which was done at a university (I know, could still be off), but I also have read a lot that a MRI is able to give a more concrete diagnosis than an ultrasound. And given that they were using the MRI as the final diagnosis and comparing the initial ultrasound diagnosis off that, the fact that the ultrasound wasn't nearly (not even half) correctly diagnosed (the 12 that were incorrectly positively diagnosed almost makes me more worried, it's not even that they were just missed), makes me wonder on how good of a tool it really is. Please, if I'm wrong, I'd love to see where I can be more confident in an ultrasound!
And yes, I would love a concrete diagnosis, I'm not saying I wouldn't. However, I don't have money for an MRI, honestly, it would cost more money than the horse. Xray combined with ultrasound would be better, but an X-ray alone isn't going to give me more information about the suspensory, is that right? Except the bone around it...I don't mean to say that she isn't worth treatment, but I need to be smart about it (which is why I really appreciate this discussion). Also, in the end, if it was maybe a tendon instead, how much would it change my treatment? I could see where if it was a bone issue that it would change my treatment quite a bit, but in that respect, the signs and symptoms probably won't to go away with my planned treatment and I'll know in a few months when she doesn't improve or when she relapses. In reality, I don't think the time off will hurt her no matter what; wrapping and using magnets isn't going to hurt...
But, I acknowledge, I definitely could be wrong. | |
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The Advice Guru
Posts: 6419
| Ridenrun4745 - 2014-05-08 9:25 PM
cheryl makofka - 2014-05-08 8:53 PM
Of course your vet wants to make another appointment as he gets to charge his flat rate exam fee again, in my area it is 60 before a vet even looks at the horse.
I also believe that an X-ray and ultrasound are only as good as the vet taking them.
I also believe in a concrete diagnosis, as then you can decide treatment plan, prognosis, etc.
I would agree with you on 'just wanting to charge me more money', but I've also read supporting evidence on his thought process of waiting on the ultrasound, and that the extra fluid from the blocking may impair the ultrasound results. Also, I don't think he will charge me another farm call. Honestly, he's an old friend, and I don't think he'd be out to take my money. I realize that could go both ways - that I'm just using him because he's an old friend and not a good lameness vet, but I am trying to research this smartly (and really, I really appreciate yours and everyone's thoughts on this, it helps! ), and am definitely learning a lot along the way.
I agree with the x-ray and ultrasound and the vet's ability, definitely. I'm not a newbie to vet work, I worked in small animal emergency medicine for quite a while in college. I thought about that while reading the MRI/ultrasound study, which was done at a university (I know, could still be off ), but I also have read a lot that a MRI is able to give a more concrete diagnosis than an ultrasound. And given that they were using the MRI as the final diagnosis and comparing the initial ultrasound diagnosis off that, the fact that the ultrasound wasn't nearly (not even half ) correctly diagnosed (the 12 that were incorrectly positively diagnosed almost makes me more worried, it's not even that they were just missed ), makes me wonder on how good of a tool it really is. Please, if I'm wrong, I'd love to see where I can be more confident in an ultrasound!
And yes, I would love a concrete diagnosis, I'm not saying I wouldn't. However, I don't have money for an MRI, honestly, it would cost more money than the horse. Xray combined with ultrasound would be better, but an X-ray alone isn't going to give me more information about the suspensory, is that right? Except the bone around it...I don't mean to say that she isn't worth treatment, but I need to be smart about it (which is why I really appreciate this discussion ). Also, in the end, if it was maybe a tendon instead, how much would it change my treatment? I could see where if it was a bone issue that it would change my treatment quite a bit, but in that respect, the signs and symptoms probably won't to go away with my planned treatment and I'll know in a few months when she doesn't improve or when she relapses. In reality, I don't think the time off will hurt her no matter what; wrapping and using magnets isn't going to hurt...
But, I acknowledge, I definitely could be wrong.
Yes, MRI would be the tool of choice, but if you don't have or cannot afford an MRI, ultrasound is the second alternative.
I haven't read any studies on this, but my questions would be X-ray and ultrasound combined would there have been as many discrepancies. I would also look at when the study was done, as ultrasound machines have improved tremendously the same as X-ray even in the last 5 years.
A few months of stall rest might not be enough depending on the severity of the issue whatever the issue may be.
Myself I have many horses whose vet bills are more then the worth of the horse, I don't look at it that way. I look at it, I bought them, they are my responsibility, and I will do whatever I possibly can to even get them pasture sound. My horses did not choose to barrel race, nor did they choose me to be their owner, I feel keeping them comfortable is the least I can do.
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 Expert
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Location: South MS | Ridenrun4745 - 2014-05-07 3:46 PM for further diagnosis or treatment of strongly suspected hindlimb proximal suspensory desmitis, where would you spend it? Today, after blocking the above the fetlock and below the hock, the vet is 90% certain it's PSD. I have the thread below where the symptoms started. I realize that it's not much money to be able to spend, at all, I know. But to start treatment or further diagnosis?
My mare tore her joint capsule in left rear fetlock - shreaded it - it was horrible and she was in alot of pain, She was turned out for 10 months after the injury, easy riding for 2 months and then went back to training.
I did 12 hours pressure wrapped in pasture and 12 hours in stall without a wrap
Every other day I was sweating it with a mix of dex, dmso, furazone and wrap with brown paper and quilt and standing wrap for 3-4 hours and then take off and rinse with hose for the first few weeks trying to reduce scar tissue - it will burn if you do it everyday
I kept her on a high quality joint supplement and continued to do Adequan monthly so help her heal - I liked this supplement personally (https://www.smartpakequine.com/smartflex-rehab-pellets-9820p)
I have since bought her Back on Track boots and she seems to love these vs the standing wraps
I ALWAYS wrap her when I ride - even if I am just trail riding - I dont take any chances for re-injury
If you can afford PRP (plate rich plasma) do it - I work at a DR office and we do PRP in our office to our patients and the results are amazing!
Time and rest are the best medicine - dont rush - a partial tear needs a min of 12 weeks to heal and then sometimes it may be longer - I would re-check in 3-6 months and go from there - go to a vet to xray/ultrasound it NOW and that way you have something to compare to later - At the time I took pics of the ultrasound screen with my phone and I had xrays to compare to when we made the decision to start riding her again. | |
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Expert
Posts: 1543
Location: MI | Thanks gals...
I would be interested on the Xray question too, if they had used it. Good question.
I agree on the stall rest possibly not being enough. And I get that vet bills are often more expensive than the horse purchase price, I shouldn't have even put that in there, really, it's a null point. I am in no way trying to shirk my responsibility as a horse owner. I respect that all of us are trying to care for the animals in the care to the best of our abilities 
LMichaels, thanks for your rehab story. :) I looked at the Smartpak Rehab Pellets yesterday, good to hear that you had a good experience with them! My vet gave me some of the same mixture for her with the same directions. Did you wrap the opposite leg as well, and put anything on it when you wrapped it? I'm thinking absorbine or sore-no-more, just to keep it happy since it's taking more of the weight/stress? I am not going to rush it, I'm figuring on giving her until next spring off, I'm fairly certain. There's no point in rushing and reinjuring, and about the time she may be ready to go back to work it'll be cold winter up here again. And thanks for the thoughts on the PRP, good to know!
Edited by Ridenrun4745 2014-05-09 10:15 AM
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If you had $250 ...