# Arthritis in both hocks - what next?



## emfen1305 (17 January 2017)

I apologise in advance, I imagine this topic has been done to death and I have read others' stories but they seem to be more on fusion and ethanol injections where as mine is more to do with steroids! I posted a few weeks ago saying my horse wasn't right but not lame and showed symptoms of just about everything from KS to SI injury, he went to Leahurst for bone scan. It came back clear bar his hocks so he was xrayed and nerve blocked and found to have mild arthritis in both hocks. He was medicated in both distal hock joints with corticosteroids and came back to me on Friday. After a totally horrendous journey back including him rearing and getting stuck on the partition, he gave himself colic (and me bruised ribs and a black eye) which coincided with the two days box rest he is now back out in the field. He is to be on turnout for 2 weeks and then gradually brought back into work with a view that in around 3 months he will be able to do his normal workload.

She said that either the bones would fuse which would solve the problem or he would continue needing injections at whatever rate he needed them. My friends horse had one injection about 8 years ago and has never needed another one since. 

I just wanted to hear people's opinions/advice/experience on any supplements/type of work/feed etc or anything related. Ideally he need's to go as long as possible without being remedicated as to be honest after Friday's experience I don't ever want to put him in a horsebox again! 

Many thanks


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## Goldenstar (17 January 2017)

It varies so much from horse to horse .
I suppose an average for horses I have known  is twice a year some more some less one of mine with mild arthritis showed a really good response to cartofen he had a course and now we do a single jab every four months .
You need to keep your horse slim and in work and avoid thing that make them worse so Fatty needs us to restrict his trotting on the road as much as we can but he's happy to be lunged in a school I do a lot of pole work unridden on him to keep the joints mobile while not bearing weight of the rider .
But each horse seems to be a little different so you just have to suck it and see.
But they need to slim and they do best when kept working that seems to be the same for all of them .


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## emfen1305 (17 January 2017)

Goldenstar said:



			It varies so much from horse to horse .
I suppose an average for horses I have known  is twice a year some more some less one of mine with mild arthritis showed a really good response to cartofen he had a course and now we do a single jab every four months .
You need to keep your horse slim and in work and avoid thing that make them worse so Fatty needs us to restrict his trotting on the road as much as we can but he's happy to be lunged in a school I do a lot of pole work unridden on him to keep the joints mobile while not bearing weight of the rider .
But each horse seems to be a little different so you just have to suck it and see.
But they need to slim and they do best when kept working that seems to be the same for all of them .
		
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Yes she said no trotting on the road if possible only on fields/soft surfaces but walking is fine! I didn't know about lunging so was going to avoid for a couple of months as i know it can put a bit of pressure on but he does his best pole work on the lunge (without me interfering on his back) so I am hoping to start doing it again. I was hoping to show him this season as a show cob but i've been told his needs to lose the 50kg he put on when he was out of work so might have to have a rethink about his classes as he would be v. lightweight but his health is more important! Thanks for your advice


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## PorkChop (17 January 2017)

Usually they advise not to lunge when hocks are involved.

There are certainly plenty of things you can try, it depends how much money you want to spend.

Cartrophen is really good, well proven, about £80 an injection if you buy and inject yourself.  Usually a course of four injections, a week apart, topped up as necessary, can be as often as monthly.

I have used Osphos before, really noticed a difference, though you will get the most benefit from the first injection, so a one off really.


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## MuddyTB (17 January 2017)

It is a bit trial and error to see what work suits your horse after steroids I think.
My lad is a happy hacker but I do trot him on the roads, (not loads but enough to keep him fit). I asked 2 vets directly if I should stop and they said it was fine as long as he is coping.

However, if I work him in the school, (ours is rubber on sand and when dry in summer can get a bit deep which makes it worse), he will often feel it the day after so I avoid schooling/lunging as much as possible.

I'd start with as much 'straight line' work as possible and see how you go. Lunging using the whole school and walking over poles/raised poles too. 

Straig


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## emfen1305 (18 January 2017)

PorkChop said:



			Usually they advise not to lunge when hocks are involved.

There are certainly plenty of things you can try, it depends how much money you want to spend.

Cartrophen is really good, well proven, about £80 an injection if you buy and inject yourself.  Usually a course of four injections, a week apart, topped up as necessary, can be as often as monthly.

I have used Osphos before, really noticed a difference, though you will get the most benefit from the first injection, so a one off really.
		
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Well i'll keep going with the expensive stuff until the insurance runs out! I've got a joint supplement coming and i'm going to spend the next few months really working on getting him to carry/use  himself properly and if no improvement then i'll turn him away, he isn't lame or in constant pain but i wanted to have him as my forever horse but we will see! Thanks


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## emfen1305 (18 January 2017)

MuddyTB said:



			It is a bit trial and error to see what work suits your horse after steroids I think.
My lad is a happy hacker but I do trot him on the roads, (not loads but enough to keep him fit). I asked 2 vets directly if I should stop and they said it was fine as long as he is coping.

However, if I work him in the school, (ours is rubber on sand and when dry in summer can get a bit deep which makes it worse), he will often feel it the day after so I avoid schooling/lunging as much as possible.

I'd start with as much 'straight line' work as possible and see how you go. Lunging using the whole school and walking over poles/raised poles too. 

Straig
		
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As soon a the nights get lighter i'll be doing short hacks every night, just limited at the moment with getting down after work but i will try long reining in the school over some poles! Just want to give him the best chance possible to come right! Thanks


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## Nicnac (18 January 2017)

My vet gave us Seraquin GLME for old boy's hocks when diagnosed with arthritis and said it was the only one he would use.  He injected him at home (has all the equipment necessary) so avoided the dreaded post sedation journeys.

The supplement smells fishy though but kept the horse going for a couple more years.  Unfortunately we did have him PTS in October as he was in pain despite injections, careful management and tildren treatments etc. but he had many other issues along with hocks.

If possible I wouldn't stable as the more they move around the better.


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## Goldenstar (18 January 2017)

I have to say I have had variable results with the tildren type treatments and I have had two do the excessive drinking thing afterwards which means you can't do it again I am not convinced it's worth the money .
There's other things you can do including targeted use of Danilon which is cheap and safe and very effective with some horses of course it's no good if you completing affiliated .


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## applecart14 (18 January 2017)

Goldenstar said:



			I have to say I have had variable results with the tildren type treatments and I have had two do the excessive drinking thing afterwards which means you can't do it again I am not convinced it's worth the money .
There's other things you can do including targeted use of Danilon which is cheap and safe and very effective with some horses of course it's no good if you completing affiliated .
		
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My horse also did excessive drinking (I assumed that was what it was as his bed was in a right mess, he wee'd for England afterwards.  And by the third treatment of Tildren (squeezed three into the 12 month insurance claim) he was quite colicky and depressed afterwards.  I can remember if was around £700 per infusion - it was time consuming for the vet who had to be there for over an hour as if you speed up the rate of infusion it can bring on colic.

When the Tildren didn't appear to have been effective we went down the fusion route.


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## C1airey (18 January 2017)

As others have said - trial and error.  We had steroid injections in both hocks in June 2015.  One was significantly worse than the other.  12 months later we repeated them and the vet struggled to get the needle in the one which had been so bad previously, so we took that to mean that that hock had almost fused.  In the meantime, the other hock had sort of caught up and was the one causing the problems which made me take him back for a second round of injections.  They seem to be holding out now, 6mths later.  We were incredibly lucky that the first round lasted a year but I was frankly neurotic about his workload.  There are performance horses out there who are less micro-managed than my Welsh X happy hacker was in 2015.  

I also try to minimise trotting on the roads, and we school out hacking in straight lines.  With a little imagination, you can do just about anything.  We take any opportunity for him to have to step over something - tree roots, poles, steps, once even a fallen log that normal horses would simply jump (!). He has to keep using his hocks. We do plenty of hill work to really work his back. Diet is a delicate balance - he needs to be skinny, but he also needs to be able to build and maintain good muscle mass. Winter can be a trial. He won't live out, but is turned out in all weathers.  He needs to be warm when he is in the stable - standing still in the cold is the worst thing.  

There are a billion joint supplements, probably because there isn't one which works for all horses all the time.  We use either cortaflex or cortavet, whichever I can find cheapest online. Be prepared to try a few.  

Finally, keep a diary.  It's a degenerative condition and it can sneak up on both of you so having a record you can look back on will help.  It will help you identify factors which make a difference, for good or bad and work out what actually works for you.  These days I jot down things like distance, pace, ground condition, weather, and general sense of how he feels. At the height of my hock neurosis, I pretty much documented every sniff, snort and f*rt.


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## emfen1305 (18 January 2017)

Nicnac said:



			My vet gave us Seraquin GLME for old boy's hocks when diagnosed with arthritis and said it was the only one he would use.  He injected him at home (has all the equipment necessary) so avoided the dreaded post sedation journeys.

The supplement smells fishy though but kept the horse going for a couple more years.  Unfortunately we did have him PTS in October as he was in pain despite injections, careful management and tildren treatments etc. but he had many other issues along with hocks.

If possible I wouldn't stable as the more they move around the better.
		
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Thanks for the advice, my vet is mobile so i'm hoping he could also inject at home, i don't 100% know what they mean by sterile environment but I won't travel him or stable him somewhere else again, this weekend's experience has totally put me off i would rather retire him before doing that to him again! 

Unfortunately I can't do 24/7 turn out where I am and the only other places around me that do it are more like retirement grazing rather than livery so it isn't an option. He can go out for 8 hours a day though and then when he is back in work i will exercise as many days as he will let me! I am sorry to hear about your horse


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## Goldenstar (18 January 2017)

They need an really clean dust free stable .


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## emfen1305 (18 January 2017)

applecart14 said:



			My horse also did excessive drinking (I assumed that was what it was as his bed was in a right mess, he wee'd for England afterwards.  And by the third treatment of Tildren (squeezed three into the 12 month insurance claim) he was quite colicky and depressed afterwards.  I can remember if was around £700 per infusion - it was time consuming for the vet who had to be there for over an hour as if you speed up the rate of infusion it can bring on colic.

When the Tildren didn't appear to have been effective we went down the fusion route.
		
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Perhaps I am being ignorant here but would they have definitely injected with Tildren? The note just says "corticosteriods" so would that likely by Tildren? The reason i asked is because he colicked on Friday night and he has never colicked before. At first I put it down to travelling but he travelled in the same box on the Monday and he has travelled in 3.5t many times before. He really didn't seem himself at all on the Friday when i went to get him but i put that down to a week in a strange place being poked and prodded but as soon as i loaded him he was pawing at the floor trying to go down and when he couldn't go down, he went up! He then had to be sedated again to travel and that's when he properly colicked on Friday night. He did drink quite a lot over the weekend as well.. he now seems to be grumpy but to be honest that's no different from usual..

I am not planning to affiliate him so danilon could work for us! I will ask the vet!


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## emfen1305 (18 January 2017)

Goldenstar said:



			They need an really clean dust free stable .
		
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Would a spare stable that has been disinfected and not had shavings down for some time work potentially?


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## emfen1305 (18 January 2017)

C1airey said:



			As others have said - trial and error.  We had steroid injections in both hocks in June 2015.  One was significantly worse than the other.  12 months later we repeated them and the vet struggled to get the needle in the one which had been so bad previously, so we took that to mean that that hock had almost fused.  In the meantime, the other hock had sort of caught up and was the one causing the problems which made me take him back for a second round of injections.  They seem to be holding out now, 6mths later.  We were incredibly lucky that the first round lasted a year but I was frankly neurotic about his workload.  There are performance horses out there who are less micro-managed than my Welsh X happy hacker was in 2015.  

I also try to minimise trotting on the roads, and we school out hacking in straight lines.  With a little imagination, you can do just about anything.  We take any opportunity for him to have to step over something - tree roots, poles, steps, once even a fallen log that normal horses would simply jump (!). He has to keep using his hocks. We do plenty of hill work to really work his back. Diet is a delicate balance - he needs to be skinny, but he also needs to be able to build and maintain good muscle mass. Winter can be a trial. He won't live out, but is turned out in all weathers.  He needs to be warm when he is in the stable - standing still in the cold is the worst thing.  

There are a billion joint supplements, probably because there isn't one which works for all horses all the time.  We use either cortaflex or cortavet, whichever I can find cheapest online. Be prepared to try a few.  

Finally, keep a diary.  It's a degenerative condition and it can sneak up on both of you so having a record you can look back on will help.  It will help you identify factors which make a difference, for good or bad and work out what actually works for you.  These days I jot down things like distance, pace, ground condition, weather, and general sense of how he feels. At the height of my hock neurosis, I pretty much documented every sniff, snort and f*rt.
		
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Thank you that's really helpful! What was your typical workload if you don't mind me asking? Luckily there is quite a bit of hacking around ours so plan to just do that as much as i can although I do have plans to show him and jump again at low heights if he is still OK with this! She said his arthritis is very mild now but it will get worse, he is only 9.  

I also can't turn out 24/7 but he does go out every day and I will work on his weight when I can start riding again.  He is a on a fatty friendly diet of just fibre mash and lite balancer but has been getting as much haylage as he wants due to the bout of ulcers he had but he isn't greedy and will always have quite a bit left as he is fussy! 

I'll start with a diary. He is just a grumpy ****** most of the time anyway but like last night for example when i picked out his right hock he wasn't happy and then had a very worried look on his face for a few mins afterwards so i suppose it is good to document those sorts of things so I can see if there is an improvement. I'll definitely know when i get back on whether there is an improvement. Honestly I'm so emotionally exhausted from this whole thing (investigations have been going on since September) I don't know whether it's best just to stick him on retirement livery somewhere and have a break! Thank you for your advice!


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## C1airey (18 January 2017)

emfen1305 said:



			Thank you that's really helpful! What was your typical workload if you don't mind me asking? Luckily there is quite a bit of hacking around ours so plan to just do that as much as i can although I do have plans to show him and jump again at low heights if he is still OK with this! She said his arthritis is very mild now but it will get worse, he is only 9.  

I also can't turn out 24/7 but he does go out every day and I will work on his weight when I can start riding again.  He is a on a fatty friendly diet of just fibre mash and lite balancer but has been getting as much haylage as he wants due to the bout of ulcers he had but he isn't greedy and will always have quite a bit left as he is fussy! 

I'll start with a diary. He is just a grumpy ****** most of the time anyway but like last night for example when i picked out his right hock he wasn't happy and then had a very worried look on his face for a few mins afterwards so i suppose it is good to document those sorts of things so I can see if there is an improvement. I'll definitely know when i get back on whether there is an improvement. Honestly I'm so emotionally exhausted from this whole thing (investigations have been going on since September) I don't know whether it's best just to stick him on retirement livery somewhere and have a break! Thank you for your advice!
		
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We went out little and often post-injections.  He is used to being ridden four or five times a week, so we kept that number of rides, but varied the type: a couple of hilly hacks, a road hack, one down an uneven track, etc.  At first we would only be out for twenty minutes, then after a couple of weeks we'd add on an extra five minutes, then an extra ten, then vary the intensity and introduce a little trot on the flat, then up a hill, then later (much later) a little canter.  If he felt sore or like he was struggling, we'd go back to what we were doing the previous week.  Mine is a bit of a tit in-hand, but if yours is well behaved, you could even start off by just walking him out and maintaining a smart pace. You'll get there in the end.

It will get worse, it's the nature of the beast, but if his hocks fuse, it will then get much, much better.  I know what you mean about finding it exhausting but now you know what you're dealing with and can make a plan, hopefully that will make it feel a bit more manageable.  Once the weather warms up, it will get easier too - knee-deep mud doesn't help, physically or emotionally.  Spring is just around the corner - hang in there!


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## emfen1305 (18 January 2017)

C1airey said:



			We went out little and often post-injections.  He is used to being ridden four or five times a week, so we kept that number of rides, but varied the type: a couple of hilly hacks, a road hack, one down an uneven track, etc.  At first we would only be out for twenty minutes, then after a couple of weeks we'd add on an extra five minutes, then an extra ten, then vary the intensity and introduce a little trot on the flat, then up a hill, then later (much later) a little canter.  If he felt sore or like he was struggling, we'd go back to what we were doing the previous week.  Mine is a bit of a tit in-hand, but if yours is well behaved, you could even start off by just walking him out and maintaining a smart pace. You'll get there in the end.

It will get worse, it's the nature of the beast, but if his hocks fuse, it will then get much, much better.  I know what you mean about finding it exhausting but now you know what you're dealing with and can make a plan, hopefully that will make it feel a bit more manageable.  Once the weather warms up, it will get easier too - knee-deep mud doesn't help, physically or emotionally.  Spring is just around the corner - hang in there!
		
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Thank you - we are very flat where I am but lots of different types of terrain both hard and soft so hopefully that will help. We do have a hill right outside our yard but it is the busy road to the tip but i suppose slowing the traffic down once a week wouldn't too terrible! I'll definitely record what I do with him and his reaction though to see how it goes - it would be worth while reading back on bad days (and good!). He is fine to walk out in hand if I have a bridle, he can get a bit tanky in a headcollar if there is nice grass around but he is also OK to longrein so I was planning doing that after his two weeks of turnout.

She said if the injections didn't work then they could do surgical fusion but that would be a last resort and I imagine very expensive as it wont be covered by insurance. When i was doing all of my research fusion with ethanol was the only thing I had come across but I don't know if it is the same thing. You're right, I am totally over thinking and over worrying about this, I suppose I have been very lucky in the past to not ever had anything go wrong and now it all comes at once! I think the weather will help, everyone is happier when the nights are lighter, only another couple of months!


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## Goldenstar (18 January 2017)

emfen1305 said:



			Perhaps I am being ignorant here but would they have definitely injected with Tildren? The note just says "corticosteriods" so would that likely by Tildren? The reason i asked is because he colicked on Friday night and he has never colicked before. At first I put it down to travelling but he travelled in the same box on the Monday and he has travelled in 3.5t many times before. He really didn't seem himself at all on the Friday when i went to get him but i put that down to a week in a strange place being poked and prodded but as soon as i loaded him he was pawing at the floor trying to go down and when he couldn't go down, he went up! He then had to be sedated again to travel and that's when he properly colicked on Friday night. He did drink quite a lot over the weekend as well.. he now seems to be grumpy but to be honest that's no different from usual..

I am not planning to affiliate him so danilon could work for us! I will ask the vet!
		
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He's not had tildren it's injected into the horses blood stream your horse has had injections into his joints .


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## emfen1305 (18 January 2017)

Goldenstar said:



			He's not had tildren it's injected into the horses blood stream your horse has had injections into his joints .
		
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Ah OK thank you - I didn't know what Tildren was, I didn't know if it was the name for the specific type of steroid! The colic must have been due to the stress then!


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## Goldenstar (19 January 2017)

emfen1305 said:



			Ah OK thank you - I didn't know what Tildren was, I didn't know if it was the name for the specific type of steroid! The colic must have been due to the stress then!
		
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The colic is likely to have been caused by the sedation slowing down the gut .
Some horses are very susceptible to this .


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## applecart14 (20 January 2017)

Goldenstar said:



			The colic is likely to have been caused by the sedation slowing down the gut .
Some horses are very susceptible to this .
		
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My horse had colic the third time he was given the infusion although he was given Tildren at a slower infusion rate to avoid this. He also wee'd for England the day after treatment.

Off the internet:

Three field studies were conducted evaluating the use of TILDREN in horses: a controlled field effectiveness study, a 6-month open use field study, and an infusion rate field safety study. In the controlled field effectiveness study, 139 horses were treated with a single intravenous infusion of TILDREN over 30-60 minutes and 69 horses were treated with vehicle control. Adverse reactions were most common during the infusion or within 4 hours following the end of the infusion (see Table 2). Fifty-seven TILDREN-treated horses (41%) and seven vehicle control horses (10%) exhibited at least one sign consistent with abdominal discomfort or colic (pawing, evidence of pawing, getting up and down, pacing, restlessness, rolling, trying to roll, looking at or biting at side, stretching out/straining, kicking at belly/walls, and shifting weight). Adverse reactions were also reported for horses in the controlled field effectiveness study that continued into a 6-month open use field study where 250 doses were administered to 97 horses. Incidence of adverse reactions was similar to the controlled field effectiveness study.


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## emfen1305 (20 January 2017)

applecart14 said:



			My horse had colic the third time he was given the infusion although he was given Tildren at a slower infusion rate to avoid this. He also wee'd for England the day after treatment.

Off the internet:

Three field studies were conducted evaluating the use of TILDREN in horses: a controlled field effectiveness study, a 6-month open use field study, and an infusion rate field safety study. In the controlled field effectiveness study, 139 horses were treated with a single intravenous infusion of TILDREN over 30-60 minutes and 69 horses were treated with vehicle control. Adverse reactions were most common during the infusion or within 4 hours following the end of the infusion (see Table 2). Fifty-seven TILDREN-treated horses (41%) and seven vehicle control horses (10%) exhibited at least one sign consistent with abdominal discomfort or colic (pawing, evidence of pawing, getting up and down, pacing, restlessness, rolling, trying to roll, looking at or biting at side, stretching out/straining, kicking at belly/walls, and shifting weight). Adverse reactions were also reported for horses in the controlled field effectiveness study that continued into a 6-month open use field study where 250 doses were administered to 97 horses. Incidence of adverse reactions was similar to the controlled field effectiveness study.
		
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That's interesting, he didn't have any tildren just the steriods. It turns out i have a bit left on my insurance so may look to go down the infusion route if he is not any better in 6-9 months as that is a more permanent and faster route i believe, once the insurance runs out i won't be in a position to be spending that kind of money on him as much as i love him!


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## doodle (20 January 2017)

Mine got it in one hock at 13. He had 2 steroid injections ( 3 weeks apart if I remember right) and never needed another one. His was the top joint so we didn't want it to fuse. He came back into full work, if I used a new instructor I would mention to them after the lesson and asked them to guess which hock and they couldn't! I lost him at 21 to an unrelated injury. 
I stopped trotting on roads and would withdraw if going xc and the ground was hard. I started putting stable wraps on in the stable at night. I also gave him synequin joint supplement which the vet prescribed so the insurance paid for for a year but then switched to naf superflex.


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## emfen1305 (20 January 2017)

Kamikaze said:



			Mine got it in one hock at 13. He had 2 steroid injections ( 3 weeks apart if I remember right) and never needed another one. His was the top joint so we didn't want it to fuse. He came back into full work, if I used a new instructor I would mention to them after the lesson and asked them to guess which hock and they couldn't! I lost him at 21 to an unrelated injury. 
I stopped trotting on roads and would withdraw if going xc and the ground was hard. I started putting stable wraps on in the stable at night. I also gave him synequin joint supplement which the vet prescribed so the insurance paid for for a year but then switched to naf superflex.
		
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That is positive to hear though I am sorry to hear you lost him! We did used to do a lot of road work and naively i did trot quite a lot thinking it would help keep him fit but walking is just as good (just takes longer!). I have thought about getting some wraps - did you used hock ones or just normal leg wraps? My friend's pony has done very well on magnetic boots, she is like a different pony so i may look into those! I have just ordered some suppleaze gold on advice from others. I think my biggest challenge will be trying to look past it and just get on with bringing him back into work, he's been off since October as we didn't know what was wrong and i didn't want to make it worse but now I'm just worried i'll forever be looking for issues! Thank you


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## Goldenstar (20 January 2017)

You will be managing it for the rest of his life but you get used to it .
TBH have arthritis myself has made me better at managing the horses with it .


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## doodle (20 January 2017)

Just normal leg wraps.


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## SEL (21 January 2017)

Mine also has arthritis in both hocks. I have been doing a lot of free schooling over raised poles whilst it's icy and it has made an enormous difference to her flexibility. To start with she was knocking them all over the place but now she is really focussing and there's a lot more action in the hind end.

There are days where I'm bullying her to work, but I visited my physio last night and it's fair to say she was brutal about making me hold myself properly too! I have an arthritic shoulder and a wonky pelvis and both are definitely better when I'm moving around.


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## applecart14 (23 January 2017)

emfen1305 said:



			That's interesting, he didn't have any tildren just the steriods. It turns out i have a bit left on my insurance so may look to go down the infusion route if he is not any better in 6-9 months as that is a more permanent and faster route i believe, once the insurance runs out i won't be in a position to be spending that kind of money on him as much as i love him!
		
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The vets normally start with steroid injections (called intra articular injection) and see how the horse responds to this over the long term.  Usually injections have to be repeated with a shorter time span in between until the vet will consider a different treatment path like Osphos or Tildren.  Tildren acts to inhibit bone deconstruction by shutting down what are known as osteoclasts. Osteoclasts are like hungry termites that digest bone, and Tildren impedes this process and by reducing bone breakdown and further degeneration, the drug reduces pain, which contributes to lameness. THe horse receives an infusion of Tildren intravenously and it is infused into a large vein where it targets any areas of arthritic changes.  Sometimes it is better to have two or three treatments a few months apart (particularly if its part of an insurance claim).

If Tildren fails to work then the only option left is either surgical hock fusion (where the hock is drilled and the holes filled with bone grafts) or chemical arthrodesis where the hock in injected firstly with contrast dye to see if there is any communication with the other joints) and then a strong solution of ethanol (pure alcohol - my horses was 97% proof) was injected into the joint to destroy cartiliage and promote fusion.

Once this procedure is done there is no going back.  There is no space left in the joint to inject anything like steroid if the procedure doesn't work.  But the results and findings of limited research and the experience of many many owners whose horses have had chemical arthrodesis have suggested that it is a very good treatment option.  It certainly worked for my lad and we were able to everything we could before and more besides including jumping, fun rides, dressage and low level RC eventing.


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## emfen1305 (23 January 2017)

applecart14 said:



			The vets normally start with steroid injections (called intra articular injection) and see how the horse responds to this over the long term.  Usually injections have to be repeated with a shorter time span in between until the vet will consider a different treatment path like Osphos or Tildren.  Tildren acts to inhibit bone deconstruction by shutting down what are known as osteoclasts. Osteoclasts are like hungry termites that digest bone, and Tildren impedes this process and by reducing bone breakdown and further degeneration, the drug reduces pain, which contributes to lameness. THe horse receives an infusion of Tildren intravenously and it is infused into a large vein where it targets any areas of arthritic changes.  Sometimes it is better to have two or three treatments a few months apart (particularly if its part of an insurance claim).

If Tildren fails to work then the only option left is either surgical hock fusion (where the hock is drilled and the holes filled with bone grafts) or chemical arthrodesis where the hock in injected firstly with contrast dye to see if there is any communication with the other joints) and then a strong solution of ethanol (pure alcohol - my horses was 97% proof) was injected into the joint to destroy cartiliage and promote fusion.

Once this procedure is done there is no going back.  There is no space left in the joint to inject anything like steroid if the procedure doesn't work.  But the results and findings of limited research and the experience of many many owners whose horses have had chemical arthrodesis have suggested that it is a very good treatment option.  It certainly worked for my lad and we were able to everything we could before and more besides including jumping, fun rides, dressage and low level RC eventing.
		
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Thank you for taking the time to explain it, when i was researching it all it seemed some went straight for the fusion and I wondered why this was never offered to me as an option but I suppose my boy's is currently very mild so seemed a bit of a drastic approach! It seems from earlier posts the Tildren has some not great side affects so I don't really want to opt for that if the time comes when the steroid injections stop working. Did you go straight for the infusion or did you have steroids, tildren and then infusion?  

Do you know roughly how much the infusion costs? My insurance will run out and then I'll be excluded so want to know whether it is worth getting the infusion done before it runs out. If he stays OK on the injections I won't rush but I know it will get worse and want to give him the best possible chance while I have the insurance!


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## applecart14 (23 January 2017)

emfen1305 said:



			Thank you for taking the time to explain it, when i was researching it all it seemed some went straight for the fusion and I wondered why this was never offered to me as an option but I suppose my boy's is currently very mild so seemed a bit of a drastic approach! It seems from earlier posts the Tildren has some not great side affects so I don't really want to opt for that if the time comes when the steroid injections stop working. Did you go straight for the infusion or did you have steroids, tildren and then infusion?  

Do you know roughly how much the infusion costs? My insurance will run out and then I'll be excluded so want to know whether it is worth getting the infusion done before it runs out. If he stays OK on the injections I won't rush but I know it will get worse and want to give him the best possible chance while I have the insurance!
		
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Hi Emfen1305 - we had the steroid injections first.  Then we had three lots of Tildren within the twelve month insurance claim period.  Then about three years later we went for the fusion as my friend had just had it done with her horse and when I enquired if it were possible with my own, my vet said it would be a good idea.

The Tildren was £700 a time (around 2009/2010). The fusion was £300 for both hocks (around 2011/2012) from my vets in Warwickshire.  That was me transporting him to them, and included the contrast xrays, injection, technique, sedation - the whole shooting match.

The only disadvantage of having Tildren that I can see was slight transient colic and an awful lot of wee the next day, both of which are nothing life threatening or to worry about.  The risk of colic can be reduced by the infusion rate increasing in duration from thirty mins to an hour or more.  It did make him depressed at the time, but what is a days depression, bit of tummy ache or a stable of wee when you consider how much more comfortable they can be.

With the chemical arthrodesis (fusion with ethanol) there is no steroid so the horse can be turned out the next day as there is no risk of laminitis. Emfen1305 its a relatively quick rehab programme in terms of what you can do with your horse, you can move up the gears swiftly to increase the rate of fusion of the hock joint which will then stabilize the hock.  Once the horse has had the procedure done the nerves inside are destroyed so there is no pain (or this is what I believe is correct).  So sensation is felt outside as normal but the pain goes immediately inside the joint.  My horse could lift his hind feet the following day so much higher to pick them out then ever before, he was immediately happier and his action improved considerably.


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## emfen1305 (23 January 2017)

applecart14 said:



			Hi Emfen1305 - we had the steroid injections first.  Then we had three lots of Tildren within the twelve month insurance claim period.  Then about three years later we went for the fusion as my friend had just had it done with her horse and when I enquired if it were possible with my own, my vet said it would be a good idea.

The Tildren was £700 a time (around 2009/2010). The fusion was £300 for both hocks (around 2011/2012) from my vets in Warwickshire.  That was me transporting him to them, and included the contrast xrays, injection, technique, sedation - the whole shooting match.

The only disadvantage of having Tildren that I can see was slight transient colic and an awful lot of wee the next day, both of which are nothing life threatening or to worry about.  The risk of colic can be reduced by the infusion rate increasing in duration from thirty mins to an hour or more.  It did make him depressed at the time, but what is a days depression, bit of tummy ache or a stable of wee when you consider how much more comfortable they can be.

With the chemical arthrodesis (fusion with ethanol) there is no steroid so the horse can be turned out the next day as there is no risk of laminitis. Emfen1305 its a relatively quick rehab programme in terms of what you can do with your horse, you can move up the gears swiftly to increase the rate of fusion of the hock joint which will then stabilize the hock.  Once the horse has had the procedure done the nerves inside are destroyed so there is no pain (or this is what I believe is correct).  So sensation is felt outside as normal but the pain goes immediately inside the joint.  My horse could lift his hind feet the following day so much higher to pick them out then ever before, he was immediately happier and his action improved considerably.
		
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Thank you  I don't think Tildren would be an option for us at that price assuming it is similar if not more now but the hock fusion sounds affordable (again, assuming it has gone up slightly) so that could be an option. My boy is 9 so still relatively young so I would like to give him the best chance at a full recovery. I don't have ambitions of becoming an eventer but low level showing, jumping and some fun rides are what we like doing so if we can get back to that I would be over the moon. 

He is currently on his second week of just being turned out and brought in with no extra work and I can already see an improvement in his hock action just going to and from the field. He is much happier in himself, playing in the field with his friends and back to his cheeky and playful ways, something very much missed when he was at his worst. He was never even slightly lame he just looked stiff and was unwilling to move forward so I am hoping the injection will last until I can make a decision about what to do. My vet is due out to see him at the beginning of March so I will definitely be discussing fusion as a possible next step as it seems the most sensible thing to do if the arthritis is only going to get worse anyway! 

Thank you for your comments!


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## applecart14 (23 January 2017)

emfen1305 said:



			Thank you 
Thank you for your comments!
		
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No problems, hope you get it sorted, anymore questions feel free to ask


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## LaurenBay (27 January 2017)

My mare was diagnosed with arthritis in both hocks in May 2015. We initially had the steroid injections which worked for 5 months.  We then had another set of steroid and a Tildren drip in the same visit. Unfortunately neither did anything to help and even on daily bute my Horse was miserable to the point I wanted to retire her. My vet wanted her to have the surgery to drill the bones. I declined as it is not 100% garunteed to work, it was too pricey for it to only have a chance of working and too much pain for my Horse.  My vet practice doesn't do the alcohol infusion. But they did inject another alcohol (not sure what called) which kills the nerve endings so the Horse cannot feel any pain.  She had both done together 2 weeks ago and is now sound  (not had bute in over a week either). What works for some Horses doesn't work for all I'm afraid so it's really trial and error. Good luck.


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## Goldenstar (27 January 2017)

Tildren can cause excessive drinking I have seen this twice .
Both horses were fine but need veterinary follow until they stabilised .
This is not weeing a bit more than normal ( which they do as the body processes the drug )this drinking bucket after bucket of water in the 48 hours following being given the drug .


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## Achinghips (28 January 2017)

Sorry to hear about your horse OP. Try not to worry too much as its a very common condition. With one of my lads, he seems to get worse in winter.  He has had two lots of steroids into both hocks and I previously had a mare who had the ethanol.   If you want that, change vets. Many do it.  It didn't work for mine though.
It's all about management really. My lad has the back on  track hock boots and I have just installed a solarium for him when it's bitter. Out 24/7 and unrugged where possible to get him to move around a bit more to warm up, though that's a balance as cold and damp makes him more stiff.  Losing weight helps, not easy as mine is a heavy horse. Finally turmeric, linseed and pepper made up like a pot noodle with hot water and tipped into his feed has started to help ... It didn't work when I used cold water.  Plentiful hacks to stop stiffening up ..... and on worst days, nothing comes close to increasing his comfort than danillon.


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