Can pony get a bone scan while on bute?

[Feathered_Feet]

After more than a year of dealing with mild KS (treated with multiple non-surgical modalities, “fixed” for a while but now presenting with back pain again), PSD (now fully “healed” after a long rehab), continuous NPA in the hind feet (now no-longer negative, but not as positive as I’d like) and heel pain when under pads, my horse is still not 100%, presenting with back pain and heel pain in the hind feet (and manifesting as poor performance under saddle). Before discussing possible KS surgery as the next step, I really want to rule out any other potential issues, and vet discussed a bone scan as a good next step.

However, last week the vet put the horse on bute and methocarb for the back pain, and although I am waiting on the vet’s response, I’m wondering if the bute might hide any inflammation we’d want to pick up on the bone scan. Should I wait until she’s off the bute and back in work to do the bone scan? Or are bone scans sensitive enough to pick up on even mild inflammation that would remain while being treated with bute? Just trying to think of the timing.

Alternatively, I think a lot of the back pain might be coming from the feet. While the hind feet alignment is improved with wedges, I’m concerned there’s some long-standing inflammation in the feet that is causing heel pain when in pads. I’m wondering if injecting the coffin joint, just to really remove any inflammation, might be a reasonable next step as a diagnostic of sorts? The horse isn’t lame, so I don’t think blocking will reveal much. It’s a subtle not-rightness which is why I think I’d have to feel how pony feels over several rides. My thinking is, if I can remove the inflammation in the feet, and she feels better, then I know the feet really are still driving the issues I’m feeling, and might then opt to pursue an MRI of the feet to see what’s really going on in there.

I’d like to avoid having to do a bone scan and then an MRI of the feet, if at all possible, but I’m close to grasping at straws, here.

And yes, I’ve been taking radiographs of the feet quarterly for the last 18 months, so not just guessing from external structures

[IPEsq]

I would wait until the horse is off of Bute, but really that’s like a day or two.

As for coffin joint injections, that’s unlikely to do much for caudal foot pain. What you can do is do a PD block and see if behavior or other clinical signs improve, although the block only lasts a few hours. That will address the back of the foot.

Bone scans also don’t give you answers with much specificity. And anything that lights up will likely require further diagnostics and imaging. That is the biggest downside to the cost of a bone scan as well as when the bone scans don’t show the real problem (possible with chronic inflammation, been there with SI issues!) and/or show a lot of mild things that could be from compensation and not the actual cause or clinical significance.

But when you have ongoing NQR-ness, a useful bone scan result will point you in the right direction, hopefully, as to what body parts to look at next.

[endlessclimb]

If you’ve got the money to blow, I’d do it (sans bute).

I have done two bone scans on two different horses - both were entirely inconclusive, and in fact may have muddied the waters even more due to abnormal findings in both. In one, a soft tissue mass lit up in the bone phase, and the other the point of the hock lit up for no discernible reason.

I could have spent that 1300 (each) better elsewhere.

[fivestrideline]

No help here. Just here to say your horse sounds like mine with KS/NPA/back pain - no PSD that we know of, but a front suspensory. He’s not lame either, just… NQR. Moves like a WP horse and won’t go forward. Everything under the sun has been suggested for this horse: massage, barefoot and/or full wedge packages, PEMF, bone scan, mri, shockwave, meso, chiro, injections in coffin joints, hocks, SI, stifles, etc etc etc

I’m interested to hear where you go with yours - my horse has been on Robaxin and we do notice a difference. Im exhausted from chasing everything so he just got moved to full turnout with friends and I’m pulling his shoes (farrier issues!! Yay!!) and leaving him alone for a while.

KS surgery had crossed my mind but like you I want to know it’s the “issue”. Therefore, bone scan. But I think I’ll be saving those Pennies for something else

[Feathered_Feet]

Thanks, for the response, IPEsq. I’m definitely leaning towards waiting until after the bute run for better results, but I guess it depends how she goes under saddle once I get her back into the swing of things. If she’s still uncomfortable while on bute, maybe there’s something to see on the camera, after all.

@IPEsq

As for coffin joint injections, that’s unlikely to do much for caudal foot pain. What you can do is do a PD block and see if behavior or other clinical signs improve, although the block only lasts a few hours. That will address the back of the foot.

I think that’s the issue. What I’m feeling is really, really subtle, so I don’t know that a few hours block will do much, especially when I’m suspicious that the pain/discomfort has “migrated” up the hind legs and through the back (since the shoeing issues have been so chronic). The horse isn’t lame by any conventional standard, and what I feel is just broad, suboptimal less-than-stellar performance, with funny posture when not under saddle (standing camped under with that foot 95% of the time, resting that foot/lifting the heel at odd times). I’m grasping at straws, I guess, for how to relieve any discomfort/inflammation in that foot for at least a few days (ideally more) so I can have a few rides and see if she feels better over a few days. Again, just an idea based off a suspicion. Maybe I should ask if there’s another area of the foot that can be injected (other than the coffin joint), if trying to use the injection diagnostically.

I agree the lack of specificity and potential for ambiguous results is what has kept me from a bone scan for the last 18 months of this game of whack-a-mole. At this point, we’ve had multiple vets look at her (only 2 are sports specialists, though), radiographed the entire spine stem-to-stern, ultrasounded most of it, radiographed the feet quarterly for 18 months, done suspensory surgery, and ruled out neuro, lyme, and metabolic issues. As far as I can tell, bone scan is the last option before taking her to a university for a full ground-up work up (was going to get the bone scan at the local full-service specialty clinic as that’s <1 hour away, but maybe it’s worth just taking her to the university 2+ hours away to have the option for both at the same time, pending bone scan results).

[Feathered_Feet]

Thanks, not so much money to blow, but without figuring out what’s wrong with this horse, I have a very, very expensive former-FEI ornament on my payroll! I guess I don’t really feel like I have an option not to pursue it (but luckily I can afford it).

If the current bute/methocarb/mesotherapy doesn’t work, I think that’s next on my list.

I suspect we’ll have some confusing findings to sort through, but hopefully more answers than red herrings!

[Feathered_Feet]

Yes I think we’ve run into each other on other threads! I agree our horses sound very similar. Hopefully yours is happier now that he’s tranqued a bit

The (another new) vet last week put her on an aggressive bute & methocarb treatment, combined with mesotherapy (for the first time - no other vet had suggested it), so we’ll see if this helps. Previously, horse had been on bute and/or methocarb at different times but never a very high methocarb dose, nor for very long. As someone who takes methocarb for my own back pain, I know it doesn’t do much at low doses. Maybe this will help.

I think at this point, next time she feels not-100% during a ride, I’m just going to schedule it. Bute or not. If she’s unwell enough to feel 100%, maybe something will show up.

Or maybe I should retire her and take up knitting. Probably less emotionally tumultuous LOL!!

[fivestrideline]

Haha yes we have! It’s a whirlwind and very fun chasing everything. I hope for answers for you - keep us posted!

[IPEsq]

I suppose injecting the navicular bursa might be an option instead of coffin joint. You don’t want to do injections close before a bone scan either, so if you think you might just go with bone scan anyway, start there.