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 Expert
Posts: 2128
  
| Getting to the point in my horses career that we need to start thinking about injections. What are some cons to having them done. I hear so much about how lots of vets do not know how to correctly inject the joints, which freaks me out. What do I have to worry about? | |
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 Scorpions R Us
Posts: 9586
 
Location: So. Cali. | Cleanliness. Make sure the area is well scrubbed and clean to avoid infection. Joint infection from injections is pretty much career ending if not life threatening.
I try to avoid injecting anything other than hocks as injections else where can cause damage to the cartilage (knees, ankles, etc.). But I do understand everyone has their opinion on management and when certain things need to be done.
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Nut Case Expert
Posts: 9305
Location: Tulsa, Ok | Obviously there is always a chance of infection, adverse reactions, etc when you start sticking needles in joints. Using a vet who is very experienced and that injections are truly needed is very important. Making sure that the work is done under very strict sterile conditions is essential. Injections are a god-send when needed and proper procedures will mitigate possible complications. | |
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 Off the Wall Wacky
Posts: 2981
Location: Louisiana | Just ask around who is the best in your general area, and haul to them. I have been to local vets, and I have driven 8 hours. As far as price goes, they're all about the same. Might as well go to the best.
A good, reputable performance horse vet. Pay for the X-rays. That's the most expensive part, but you'll know what you're dealing with. And then have them to compare for the rest of your horse's life.
Write down observations you want to mention, and any questions you want to ask. Bc you will forget in the moment lol. | |
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The Advice Guru
Posts: 6419
| There is a lot to think about when injecting a horse.
Vets are not always current on treatments.
You need to answer these questions before you interview vets. Why are you injecting, what are you hoping to accomplish, and what is your expected longetivity of the horse?
If you are injecting as a preventative or maintance (mild arthritis no or little cartilage damage) then I would look at injecting HA and trimethsclione. I would not inject betamethasone, or depomedrol, or any other steroid as the two I said I wouldn't the scientific research shows that these accelerate the destruction of cartilage, where as the trimethsclione will actually help promote cartilage repair.
There are many vets that will want to inject the betamethasone or the depomedrol, or methylprednisone into a hock to increase hock fusion. The studies I have read all published in peer reviewed journals show that these steroids actually prevent healing in joints, so yes it will cause the horse to be bone on bone faster, but they will not fuse properly. My vet is the coauthor who invented the laser hock fusion refuses to fuse a horse who has had the above steroids injected in as he says the horses he has done in the past would not fuse properly therefore a waste of money for the owners.
Not all HA is created equal, you get what you pay for. Legend IA is cheap and doesn't have the high molecular content therefore breaks down a lot faster. Hylartil 4 is a high molecular HA and lasts longer, but it is pricey, when I had to inject coffin joints, this was 150 a joint just for the HA not the procedure.
When you actually get to the injecting, as the vet what his infection rate is, he should be able to tell you, if he cant move on.
Vets are trying to get away from physically scrubbing the joint, and are using more of a clean technique, don't let them. The joint site should be scrubbed for 7 minutes. I used to scrub my own sites. The mechanical part of scrubbing will actually get rid of more bacteria then the chemicals used.
After the site is sterilized do not allow the vet to break sterile procedure, do not let them pick up a leg or anything, this is how you get infected joints, I had a not regular vet inject my horse once and he infected 2/4 joints because he did this.
The two main risks your horse will experience is joint flare, and infection.
If you want to learn more about these two message me.
I am not a vet, I have just educated myself on this extensively by text books, journal articles, and experience. | |
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 BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | cheryl makofka - 2016-11-24 4:08 PM
There is a lot to think about when injecting a horse.
Vets are not always current on treatments.
You need to answer these questions before you interview vets. Why are you injecting, what are you hoping to accomplish, and what is your expected longetivity of the horse?
If you are injecting as a preventative or maintance (mild arthritis no or little cartilage damage) then I would look at injecting HA and trimethsclione. I would not inject betamethasone, or depomedrol, or any other steroid as the two I said I wouldn't the scientific research shows that these accelerate the destruction of cartilage, where as the trimethsclione will actually help promote cartilage repair.
There are many vets that will want to inject the betamethasone or the depomedrol, or methylprednisone into a hock to increase hock fusion. The studies I have read all published in peer reviewed journals show that these steroids actually prevent healing in joints, so yes it will cause the horse to be bone on bone faster, but they will not fuse properly. My vet is the coauthor who invented the laser hock fusion refuses to fuse a horse who has had the above steroids injected in as he says the horses he has done in the past would not fuse properly therefore a waste of money for the owners.
Not all HA is created equal, you get what you pay for. Legend IA is cheap and doesn't have the high molecular content therefore breaks down a lot faster. Hylartil 4 is a high molecular HA and lasts longer, but it is pricey, when I had to inject coffin joints, this was 150 a joint just for the HA not the procedure.
When you actually get to the injecting, as the vet what his infection rate is, he should be able to tell you, if he cant move on.
Vets are trying to get away from physically scrubbing the joint, and are using more of a clean technique, don't let them. The joint site should be scrubbed for 7 minutes. I used to scrub my own sites. The mechanical part of scrubbing will actually get rid of more bacteria then the chemicals used.
After the site is sterilized do not allow the vet to break sterile procedure, do not let them pick up a leg or anything, this is how you get infected joints, I had a not regular vet inject my horse once and he infected 2/4 joints because he did this.
The two main risks your horse will experience is joint flare, and infection.
If you want to learn more about these two message me.
I am not a vet, I have just educated myself on this extensively by text books, journal articles, and experience.
What is trimethsclione? I haven't heard of this. Can you post a link? | |
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 Total Germophobe
Posts: 6437
Location: Montana | cheryl makofka - 2016-11-24 3:08 PM There is a lot to think about when injecting a horse. Vets are not always current on treatments. You need to answer these questions before you interview vets. Why are you injecting, what are you hoping to accomplish, and what is your expected longetivity of the horse? If you are injecting as a preventative or maintance (mild arthritis no or little cartilage damage) then I would look at injecting HA and trimethsclione. I would not inject betamethasone, or depomedrol, or any other steroid as the two I said I wouldn't the scientific research shows that these accelerate the destruction of cartilage, where as the trimethsclione will actually help promote cartilage repair. There are many vets that will want to inject the betamethasone or the depomedrol, or methylprednisone into a hock to increase hock fusion. The studies I have read all published in peer reviewed journals show that these steroids actually prevent healing in joints, so yes it will cause the horse to be bone on bone faster, but they will not fuse properly. My vet is the coauthor who invented the laser hock fusion refuses to fuse a horse who has had the above steroids injected in as he says the horses he has done in the past would not fuse properly therefore a waste of money for the owners. Not all HA is created equal, you get what you pay for. Legend IA is cheap and doesn't have the high molecular content therefore breaks down a lot faster. Hylartil 4 is a high molecular HA and lasts longer, but it is pricey, when I had to inject coffin joints, this was 150 a joint just for the HA not the procedure. When you actually get to the injecting, as the vet what his infection rate is, he should be able to tell you, if he cant move on. Vets are trying to get away from physically scrubbing the joint, and are using more of a clean technique, don't let them. The joint site should be scrubbed for 7 minutes. I used to scrub my own sites. The mechanical part of scrubbing will actually get rid of more bacteria then the chemicals used. After the site is sterilized do not allow the vet to break sterile procedure, do not let them pick up a leg or anything, this is how you get infected joints, I had a not regular vet inject my horse once and he infected 2/4 joints because he did this. The two main risks your horse will experience is joint flare, and infection. If you want to learn more about these two message me. I am not a vet, I have just educated myself on this extensively by text books, journal articles, and experience.
Sorry, OP, I don't have anything to say other than I just love reading what cheryl makofka writes. Cheryl, you are very well informed and a wealth of information. | |
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The Advice Guru
Posts: 6419
| Sorry I have never been able to post anything, I did spell it wrong the proper spelling is Triamcinolone. If you Google it there are publications, and you are a doctor so I believe you would have access to Pub Med.
I have a vet pharmacology text that I utilize to ensure I have the most current info. I replace it every few years. | |
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | cheryl makofka - 2016-11-25 12:16 PM
Sorry I have never been able to post anything, I did spell it wrong the proper spelling is Triamcinolone. If you Google it there are publications, and you are a doctor so I believe you would have access to Pub Med.
I have a vet pharmacology text that I utilize to ensure I have the most current info. I replace it every few years.
OK that's what I figured. Triamcinolone, methylprednisolone, and betamethazone are all steroids. In humans, recent studies show no significant difference in terms of effects on cartilage one way or the other, between the three. Any differences are very minor, both in terms of causing damage or even protecting cartilage. In humans, triamcinolone is generally preferred over other steroids because it is less soluble that the other steroids, so it lasts longer. That's the only real advantage. Effects on cartilage or the bone between the 3 steroids are not significantly different in humans. Also, in humans, it appears that repeated joint injections are not nearly as detrimental as once believed. Double blind studies comparing frequent injections with steroids versus placebo have not demonstrated any real significant differences, long term.
The main concern, obviously, is cost as well as risk of introducing a joint infection. In humans that risk is probably less than 1:10,000 per injection. In horses, judging from what I've seen in terms of safety and technique, that risk is much much higher. Some vets make me cringe the way they inject things. | |
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 Own It and Move On
Location: The edge of no where | Bear - 2016-11-25 1:06 PM cheryl makofka - 2016-11-25 12:16 PM Sorry I have never been able to post anything, I did spell it wrong the proper spelling is Triamcinolone. If you Google it there are publications, and you are a doctor so I believe you would have access to Pub Med. I have a vet pharmacology text that I utilize to ensure I have the most current info. I replace it every few years. OK that's what I figured. Triamcinolone, methylprednisolone, and betamethazone are all steroids. In humans, recent studies show no significant difference in terms of effects on cartilage one way or the other, between the three. Any differences are very minor, both in terms of causing damage or even protecting cartilage. In humans, triamcinolone is generally preferred over other steroids because it is less soluble that the other steroids, so it lasts longer. That's the only real advantage. Effects on cartilage or the bone between the 3 steroids are not significantly different in humans. Also, in humans, it appears that repeated joint injections are not nearly as detrimental as once believed. Double blind studies comparing frequent injections with steroids versus placebo have not demonstrated any real significant differences, long term. The main concern, obviously, is cost as well as risk of introducing a joint infection. In humans that risk is probably less than 1:10,000 per injection. In horses, judging from what I've seen in terms of safety and technique, that risk is much much higher. Some vets make me cringe the way they inject things.
Thanks! This is interesting. | |
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The Advice Guru
Posts: 6419
| Bear - 2016-11-25 1:06 PM
cheryl makofka - 2016-11-25 12:16 PM
Sorry I have never been able to post anything, I did spell it wrong the proper spelling is Triamcinolone. If you Google it there are publications, and you are a doctor so I believe you would have access to Pub Med.
I have a vet pharmacology text that I utilize to ensure I have the most current info. I replace it every few years.
OK that's what I figured. Triamcinolone, methylprednisolone, and betamethazone are all steroids. In humans, recent studies show no significant difference in terms of effects on cartilage one way or the other, between the three. Any differences are very minor, both in terms of causing damage or even protecting cartilage. In humans, triamcinolone is generally preferred over other steroids because it is less soluble that the other steroids, so it lasts longer. That's the only real advantage. Effects on cartilage or the bone between the 3 steroids are not significantly different in humans. Also, in humans, it appears that repeated joint injections are not nearly as detrimental as once believed. Double blind studies comparing frequent injections with steroids versus placebo have not demonstrated any real significant differences, long term.
The main concern, obviously, is cost as well as risk of introducing a joint infection. In humans that risk is probably less than 1:10,000 per injection. In horses, judging from what I've seen in terms of safety and technique, that risk is much much higher. Some vets make me cringe the way they inject things.
I don't look at the human studies, and I am not infront of my text books, or have access to the journal articles, it is the metabolite of the methyl prednisone that has been tested in the joint up to 6 months later, and it is the metabolite that prevents the bone remodeling. The triamcinolone in one study 80 percent of the horses showed improvement with this steroid and HA versus the other two.
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Elite Veteran
Posts: 1165
Location: California | Thank you for that info! I've done extensive research on injections for horses but I myself am nown facing spine injections and have not done near enough research! Great information to know! | |
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | cheryl makofka - 2016-11-25 3:21 PM
Bear - 2016-11-25 1:06 PM
cheryl makofka - 2016-11-25 12:16 PM
Sorry I have never been able to post anything, I did spell it wrong the proper spelling is Triamcinolone. If you Google it there are publications, and you are a doctor so I believe you would have access to Pub Med.
I have a vet pharmacology text that I utilize to ensure I have the most current info. I replace it every few years.
OK that's what I figured. Triamcinolone, methylprednisolone, and betamethazone are all steroids. In humans, recent studies show no significant difference in terms of effects on cartilage one way or the other, between the three. Any differences are very minor, both in terms of causing damage or even protecting cartilage. In humans, triamcinolone is generally preferred over other steroids because it is less soluble that the other steroids, so it lasts longer. That's the only real advantage. Effects on cartilage or the bone between the 3 steroids are not significantly different in humans. Also, in humans, it appears that repeated joint injections are not nearly as detrimental as once believed. Double blind studies comparing frequent injections with steroids versus placebo have not demonstrated any real significant differences, long term.
The main concern, obviously, is cost as well as risk of introducing a joint infection. In humans that risk is probably less than 1:10,000 per injection. In horses, judging from what I've seen in terms of safety and technique, that risk is much much higher. Some vets make me cringe the way they inject things.
I don't look at the human studies, and I am not infront of my text books, or have access to the journal articles, it is the metabolite of the methyl prednisone that has been tested in the joint up to 6 months later, and it is the metabolite that prevents the bone remodeling. The triamcinolone in one study 80 percent of the horses showed improvement with this steroid and HA versus the other two.
I'm not sure I follow you. I assume you are talking about methylprednisolone, not "methyl prednisone". In any case, I was saying that the reason Triamcinolone ("Kenalog") is a better agent versus say methylprednisolone, is precisely because it is less soluble, and therefore the systemic absorption is significantly delayed.....in other words, it sticks around longer. I'm unaware of any metabolism of steroids within the joint fluid, but feel free to correct me if I'm wrong. Steroids compounds, both endogenous and exogenous, are metabolized almost entirely within the liver. That's just basic science, and I'm fairly confident it's basically the same in all mammals. I don't need PubMed for this.
Basically, I am agreeing with you that Triamcinolone is preferred, and I spelled out the reasons why. | |
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| I don't care if you are human or horse ....... there is no re-growth to abused cartilage .... all you can do is increase the fluids and let them act as a shock absorber for an extended period of time.
Each time you inject a joint .. there is degradation to the area.... so decide if temporary use is better or not and keep in mind horse or you will be worse the more you inject .... all you are doing is providing temporary relief ....
Layoff time can be your best long term friend ...
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | BARRELHORSE USA - 2016-11-25 4:47 PM
I don't care if you are human or horse ....... there is no re-growth to abused cartilage .... all you can do is increase the fluids and let them act as a shock absorber for an extended period of time.
Each time you inject a joint .. there is degradation to the area.... so decide if temporary use is better or not and keep in mind horse or you will be worse the more you inject .... all you are doing is providing temporary relief ....
Layoff time can be your best long term friend ...
I'm not crazy about injections, personally. I'm just correcting a few errors. My biggest concern is the infection concerns. Some people, including some vets, don't even have a clue when it comes to aseptic technique. If I had to depend on a horse for my bread and butter, I'm sure I would inject if clearly indicated. I've done it a couple times on horses as a "maintenance" measure. Looking back, I think that was probably foolhardy. I would do it the right way......go to the best vet and don't take shortcuts.
In people, they can be a Godsend. I'll tell you that much. | |
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| Bear - 2016-11-25 5:04 PM
BARRELHORSE USA - 2016-11-25 4:47 PM
I don't care if you are human or horse ....... there is no re-growth to abused cartilage .... all you can do is increase the fluids and let them act as a shock absorber for an extended period of time.
Each time you inject a joint .. there is degradation to the area.... so decide if temporary use is better or not and keep in mind horse or you will be worse the more you inject .... all you are doing is providing temporary relief ....
Layoff time can be your best long term friend ...
I'm not crazy about injections, personally. I'm just correcting a few errors. My biggest concern is the infection concerns. Some people, including some vets, don't even have a clue when it comes to aseptic technique. If I had to depend on a horse for my bread and butter, I'm sure I would inject if clearly indicated. I've done it a couple times on horses as a "maintenance" measure. Looking back, I think that was probably foolhardy. I would do it the right way......go to the best vet and don't take shortcuts.
In people, they can be a Godsend. I'll tell you that much.
BEAR; I agree with you wholeheartedly ....
For us old humans ... pain relief can enhance your life for several years while you are waiting to die ... lol ...
I think what people do not realize is joint bones have grooves worn in them or have worn down to some jagged edges which creates the inflammation and pain etc etc ....
Racing young horses with growth plates still growing is a bad situation ... the growing ends of the bones are soft like cartilage waiting to be calcified and can be worn into a groove very easily and then when put to speed the joint slops around and gives you a bone chip ... which 80% never recover from.
Another factor is the horses pain memory .... if they are sore or hurt going flat out on the track ... most horses will backoff to a fast gallop and no amount of batting, sparking can get them to work any faster ..... barrel racers unknowingly complain about this all the time ... it is similar to HOTSHOT with his stifle problem ... they put the younger sister on him with less weight and let him work at his comfort zone until he was used up ....
You are so right on aseptic cleanliness .... I just cringe when I read of some muslim "nurse" refusing to wash hands or change gloves between patients and they remain on the job .... then people wonder why flesh eating bacteria and staff runs rampant at a lot of hospitals ..
I am a little nuts on cross contamination on horses or dogs .... if my animals can be treated out side at my trailer without going inside the vet clinic this is what I do!! ..... I look at the vet clinics as places where sick animals go that are probably sicker than mine or will give mine what they have... I see pet waiting rooms filled with people allowing their dogs to lick each other, roll on the floors and just run around ....... or with horses at events letting their horses nose each other or drink out of common water tubs etc etc ..... myself ... I don't want to take home another germ from someone else's animals ...
You might call me an aseptic tree hugger in this one sense .... any barn or horse equipment I can place out in the sun several times a year or like my travel horse blankets ... I wash and rinse and let them dry out in the sun flipping them over to the suns rays .... I am so dumb ... I will also make sure a sick horse is placed out into the sun to get the benefits from clean air and the varmint killing rays of the sun... lol ... I think all this stall rest is non-sense ... a horse will only move around if it feels like it and is more healthy IMO ... to be in a larger pen than a stall ... if a horse is stall bound to heal it will be a tight healing and horse will have to rip the muscles or nerves etc when you get the ok to turn our or is rowdy and fresh if you hand walk one ... so I let mine heal out where they can walk around and not have all that pent up energy or harm to the other feet ..
My horse doctoring is from years of owning horses and having a common sense attitude .... my simple cures are dissed by our vetting crowd with the mindset ... if the vet bill is nothing or not more than a thousand dollars you are mistreating your horses ... always looking for that miracle cure proposed by marketing people ... and on general up keep the Power Pack is the biggest ripoff ever ever ... lol
Injections are a foreign invasion into a joint ... I can recall the first time I saw a horse injected in the shoulder .... the needle looked to be 10 ft long and of course the vets are doing a hit and miss on finding the area to penetrate .... I almost asked for some pain killer because my shoulder was flinching during the horse process. ... lol
OK ... CONTINUE AS YOU WERE...
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 My Heart Be Happy
Posts: 9159
Location: Arkansas | Bear - 2016-11-25 5:04 PM
BARRELHORSE USA - 2016-11-25 4:47 PM
I don't care if you are human or horse ....... there is no re-growth to abused cartilage .... all you can do is increase the fluids and let them act as a shock absorber for an extended period of time.
Each time you inject a joint .. there is degradation to the area.... so decide if temporary use is better or not and keep in mind horse or you will be worse the more you inject .... all you are doing is providing temporary relief ....
Layoff time can be your best long term friend ...
I'm not crazy about injections, personally. I'm just correcting a few errors. My biggest concern is the infection concerns. Some people, including some vets, don't even have a clue when it comes to aseptic technique. If I had to depend on a horse for my bread and butter, I'm sure I would inject if clearly indicated. I've done it a couple times on horses as a "maintenance" measure. Looking back, I think that was probably foolhardy. I would do it the right way......go to the best vet and don't take shortcuts.
In people, they can be a Godsend. I'll tell you that much.
I've never had a horse injected, but I got my shoulder done Tuesday and it is SO much better today. Not great yet, but I feel like I'm on the right road. (Wednesday and Thursday weren't so special tho!!) | |
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The Advice Guru
Posts: 6419
| In my equine clinical pharmacology text page 122
Despite the persistence of MPA levels for 5-39 days after injection the active metabolite was only identifiable for 2-6 days.
In the same study MPA induced the synthesis of small non aggregating proteoglycans... Reducing proteoglycan retention in the matrix.
MPA joints had significantly lower glycosaminoglycan content in the articulate cartilage
Triamcinolone
Unlike the results described for MPA .... Resulted in significantly less lameness lower total protein higher ha and glycosaminoglycan concentrations in synovial fluid, less inflammatory cell infiltration ... And improved articulate cartilage.
Microscopic evidence of improved cartilage health improved cartilage health included a reduced percentage of immunoreactive chrondrocytes for stromelysin
I don't have time to quote the other text books
One other thing the op should know is if your horse is on steroids for respiratory you need to tell the vet, as there is a certain threshold that can be used. If you go over that there is a good chance the horse will founder. | |
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | cheryl makofka - 2016-11-25 7:49 PM
In my equine clinical pharmacology text page 122
Despite the persistence of MPA levels for 5-39 days after injection the active metabolite was only identifiable for 2-6 days.
In the same study MPA induced the synthesis of small non aggregating proteoglycans... Reducing proteoglycan retention in the matrix.
MPA joints had significantly lower glycosaminoglycan content in the articulate cartilage
Triamcinolone
Unlike the results described for MPA .... Resulted in significantly less lameness lower total protein higher ha and glycosaminoglycan concentrations in synovial fluid, less inflammatory cell infiltration ... And improved articulate cartilage.
Microscopic evidence of improved cartilage health improved cartilage health included a reduced percentage of immunoreactive chrondrocytes for stromelysin
I don't have time to quote the other text books
One other thing the op should know is if your horse is on steroids for respiratory you need to tell the vet, as there is a certain threshold that can be used. If you go over that there is a good chance the horse will founder.
Cheryl, I have a couple suggestions for you. Before you post something you copy from a textbook, make sure you understand it first. Also, avoid acronyms, whenever possible, especially those from medical text books. I doubt most people know what "MPA" stood for......so the minute they ran into this, you lost them.
Basically, you said what I said earlier, except your explanation sounds more esoteric. We both agree that Triamcinolone is superior to the other corticosteroids. I gave an explanation that is accurate and easy to understand. Read it, understand it, and explain it in a such a way that the readers also understand it and take away something meaningful and lasting. Most people don't know what stromelysin is, and most people don't care. | |
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 Take a Picture
Posts: 12838
| Bear - 2016-11-25 10:53 PM
cheryl makofka - 2016-11-25 7:49 PM
In my equine clinical pharmacology text page 122
Despite the persistence of MPA levels for 5-39 days after injection the active metabolite was only identifiable for 2-6 days.
In the same study MPA induced the synthesis of small non aggregating proteoglycans... Reducing proteoglycan retention in the matrix.
MPA joints had significantly lower glycosaminoglycan content in the articulate cartilage
Triamcinolone
Unlike the results described for MPA .... Resulted in significantly less lameness lower total protein higher ha and glycosaminoglycan concentrations in synovial fluid, less inflammatory cell infiltration ... And improved articulate cartilage.
Microscopic evidence of improved cartilage health improved cartilage health included a reduced percentage of immunoreactive chrondrocytes for stromelysin
I don't have time to quote the other text books
One other thing the op should know is if your horse is on steroids for respiratory you need to tell the vet, as there is a certain threshold that can be used. If you go over that there is a good chance the horse will founder.
Cheryl, I have a couple suggestions for you. Before you post something you copy from a textbook, make sure you understand it first. Also, avoid acronyms, whenever possible, especially those from medical text books. I doubt most people know what "MPA" stood for......so the minute they ran into this, you lost them.
Basically, you said what I said earlier, except your explanation sounds more esoteric. We both agree that Triamcinolone is superior to the other corticosteroids. I gave an explanation that is accurate and easy to understand. Read it, understand it, and explain it in a such a way that the readers also understand it and take away something meaningful and lasting. Most people don't know what stromelysin is, and most people don't care.
Well said. Instead of cutting and pasting, paraphrasing would be much better even for those of us with a strong science background. My vet does even explain things in that terminology.
By the way, I use Schwartz in Benton LA for OP (original poster)
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