Vet case study: Arthritis and navicular [H&H VIP]

  • The horse
    Spring Ginger (Chloe), a 16hh 16-year-old (born 1998) Irish Sports Horse by White Clover, is owned by Angela Bishop and regularly competes at dressage up to medium level.

    The first warning signs
    When any horse owner hears the words arthritis and navicular in the same sentence, it fills them with dread. Many assume the horse will be destined to life in the field in early retirement. But that was not the case for Angela who, on discovering her mare had both debilitating diseases, was determined to prove there is life after this diagnosis.

    When Angela first purchased Chloe — a nervous seven-year-old who had been harshly treated in her early years  — her intentions were to showjump. But when the mare showed promising movement on the flat, she switched disciplines and began dressage. However, it was not long until Angela noticed something was not quite right with Chloe.

    In October 2011 during a dressage competition at Patchetts, Chloe was struggling to canter. Angela says: “She has always been good in canter and got nice marks, so when she started feeling awkward, I became very concerned as it was not normal for her.”

    Vet referral
    As standard practice and because there was no obvious cause to her problem, Chloe’s vet put her on a course of Danilon Equidos — a non-steroidal anti-inflammatory and painkilling drug similar to Bute, used for minor strains, as a general painkiller and to reduce swelling. But when this had little effect, Chloe was referred to Rossdales Equine Hospital, after Angela, who has owned Chloe for eight years, had a gut feeling there was a more underlying problem.

    Rossdales did various tests on Chloe, from nerve blocks, to X-rays and bone scans. Eventually the vets established there were changes to her sacroiliac — the equivalent to the human pelvis, situated behind where the saddle sits in front of the rump — and associated spinal disc, in particular her lumbo-sacral region. There was also a problem with her hocks or the upper suspensory ligaments in her hind legs — the ligaments just below the hocks.

    Steroids were promptly injected into her sacroiliac — steroids reduce inflammation and slow down the degeneration of affected areas — and she was sent home. Three sessions of shock wave treatment were arranged to see if that had any effect on her upper suspensory ligaments. The technique creates shock waves that are emitted and directed onto the injured area. When they encounter the interfaces between different tissues, changes occur which include an increase in blood flow, direct effects on the cells and an analgesic (painkilling) effect.

    Although this did provide some pain relief for Chloe, it was short-lived and Angela began to feel her go downhill again.

    Rossdales suggested that since the shock wave treatment hadn’t had a long-term effect the problem was more likely to be in Chloe’s hocks, suggesting arthritis. They recommended her hocks were injected with steroids and Chloe’s vet Lisa Grahame carried this out.

    “Following the injections she had a few days off to allow the injections to kick in, and then I started doing some light work with her,” Angela says. “Soon after getting her back in work, I felt Chloe was again carrying most of her weight on her front toes. Instead of focusing more on the hind legs, I asked my vet to investigate her front feet.”

    It was not good news — X-rays showed deterioration to the navicular bones, the right hoof was slightly worse than the left.

    Help from the farrier
    Angela consulted Chloe’s then farrier, Dan Williamson to decide the best way to shoe Chloe. Dan cut back her front toes and put on Natural Balance shoes. These specially designed shoes don’t have toe clips and are tapered at the toe. They are set back on the foot which allows for a more natural foot action [break-over point], and thus takes pressure off the heel area of the foot where the navicular is situated.

    “Her new shoes had a fantastic effect, Chloe started working properly and we were competing at elementary and doing quite well. I felt I had finally had a breakthrough with her,” says Angela.

    Alternative treatment
    Just when Angela thought she had overcome Chloe’s problems, at the beginning of 2013 — 2 years since her initial hock injections and navicular diagnosis — Angela again felt Chloe was trying to carry her weight on her front toes.

    Having now moved house to a different area of the country, Angela had to find a new vet and farrier. “I consulted my new vet Hans Delaunois-Vanderperren from Norfolk Equine Veterinary Services. He was reluctant to give Chloe more steroid injections into her hocks, explaining that once injections are started then they have to be done with increasing frequency.”

    Chloe was due to be shod and Angela had already decided to discuss options with her new farrier, Mark Skippon. Hans was happy with this course of action.

    Angela found inspiration whilst reading a Horse & Hound article about rolled-toe hind shoes for horses with hock problems, and discussed this further with her new farrier. Chloe soon had these fitted onto her back feet and the improvement was significant.

    “Chloe has not looked back since having these new shoes. They have lateral extensions — so they are wider at the heel on the outside.  This improves her balance and takes pressure off the hocks and fetlocks, and along with the rolled toe is what makes the shoes so brilliant for horses with hock problems and arthritis.” Angela says.

    “She is now 16 but has never felt so good. We are just starting to compete at medium level. I take her to shows two or three times a month, sometimes two days in a row and she has been great.

    ”Chloe is finally able to work correctly and is starting to understand what I am asking of her. She is now getting stronger behind and is starting to find the work easier. We do have to be careful what surfaces we work on and have to accept that if an arena is a bit on the firm side then we will get comments about needing more impulsion.  This is always worse when Chloe is due for shoeing.”

    Angela and Chloe are proof that just because there has been a worrying diagnosis, it does not necessarily mean the end of the road — it just requires determination, perseverance and some investigation.

    Keeping Chloe happy
    Chloe receives regular treatment from a McTimoney Chiropractor, and Angela feeds her two scoops daily of Premier Flex Plus supplement, which has added Devils Claw in it. This supplement is one of many that support joints and ligaments and aids the regeneration of joint fluid. Devil’s Claw is a natural anti-inflammatory and is not a banned substance unlike both Bute and Danillon.

    Since being on the supplement Chloe’s hocks have become more flexible and she is able to pick up her back legs more easily. Angela also ensures the mare always wears her Bioflow magnet band on one hind leg — both in the stable and in the field. The band contains powerful magnets believed to encourage blood flow.

    “My chiropractor was amazed at how much Chloe has improved and muscled-up over the past six months. She is now finally developing a top line and is using herself correctly,” says Angela.

    “It has been a long journey and not an easy one at that, but there is light at the end of the tunnel. It’s not only what the vets can do, but also what correct farriery, correct training and good joint supplements can do too.

    “Chloe is proof that horses with such problems can live useful lives, and don’t have to become field ornaments or be euthanised.”

    The Costs
    Veterinary treatment: £4,200.00
    Supplements: £79.99 for 240 days (free delivery)
    Bioflow magnetic leg band: £35.00

    Vet: Lisa Grahame: (Has her own veterinary practice based in East Hertfordshire)
    Vet: Hans Delaunois-Vanderperren of Norfolk Equine Veterinary Services
    Farrier: Mark Skippon (Norfolk and Kent)
    Physio: Nicky Jennings (Norfolk, Cambridgeshire)