Dropped Fetlock in Older Horse

[RhythmNCruise]

Just a reminder that not all horses go downhill slowly and dwindle away when it’s time to go. My 28-year old gelding was perfectly fine one day, then NQR one morning at feeding time. Two days later he was put down. No real idea what it was, but it was internal, he was in a lot of distress (not like normal colic, but something was causing him a lot of pain…he stood all drawn up and paced incessantly.). I had to call the vet out on Christmas Eve. She took one look at him and said, “He’s in a LOT of pain.” Her meaning was clear. My heart broke, but I knew she was right. I didn’t want to put him through anything that would likely cause him more stress. So, I said goodbye. Worst Christmas Eve ever.

My 23-year old gelding was the picture of health…except I found him in the pasture with his leg broken in several places. He was my “heart horse”…love of my life. Losing him almost killed me.

Both of these were blessings in disguise. Each case was clear-cut. No drawn-out illness or lameness. No watching my horse’s condition decline gradually. They had good lives and were healthy, sound horses…until they weren’t.

[Amy3996]

I would also suggest getting a second opinion from a different vet if possible. Going from inadequate dosages for acute pain to stacking NSAIDs makes me think that you are maybe not getting the best guidance from your horse’s care team.

A joint supplement is wasted money for an aged horse with the symptoms you’ve described.

[JB]

@IPEsq

You can stack NSAIDs while monitoring kidney and liver values in extreme cases, but without founder risk or obvious trauma, I would seriously question whether that is the right thing here.

You’re right, I just hate to even mention that because someone will take it on themselves But even then, it’s been proven that you don’t get double the effect by doubling up, you get a much smaller % increase in benefits. And even THEN I wouldn’t do it, ever, in a situation for which there is no recovery, like this one.

@Amy3996

I would also suggest getting a second opinion from a different vet if possible. Going from inadequate dosages for acute pain to stacking NSAIDs makes me think that you are maybe not getting the best guidance from your horse’s care team.

Yeah, something isn’t adding up

@Amy3996

A joint supplement is wasted money for an aged horse with the symptoms you’ve described.

100% agree.

That said, if a proper dose of bute was making improvements, or IM Adequan was used (or both), and you wanted to add a joint supplement to try to maximize things, go for it. But it’s highly unlikely a supplement is going to make a dent in this case on its own.

[Simkie]

Is there even a diagnosis here? Or is it just that the horse is in obvious pain and it’s not clear why–which is what I’m getting from your posts @snaffle1987.

If the later, what’s preventing you from pursuing an actual diagnosis? This may be something treatable or manageable, or it may not be something treatable or manageable. Trying to treat or manage something that will never successfully be treated or managed is just cruel.

Figure out what it is (with a different vet of need be, yours sounds to have zero interest or urgency) and then game plan.

Btw, the reason I clicked here is that I do have a horse with a totally blown suspensory, and a dropped fetlock. It’s been a long road, but never over the course of this journey has she been in the amount of pain you describe in your horse.

[skydy]

@snaffle1987

Hello All

I have an older horse (30+ years) who has started exhibiting rather severe discomfort in recent weeks (6-8 weeks). He has slightly dropped rear fetlocks, although by no means severe. He has been fine up until about 8 weeks ago when discomfort looked similar to founder and led us to believe was going through a bout of it with the spring grass, etc and was immediately put on stall rest and other precautions. The vet checked him initially and he was 100% negative to hoof testers and founder was ruled out as the stiffness appears to be originating the hind end.

There is absolutely no heat or swelling in any of the limbs.

He is reluctant to move much, turning is now moderately difficult and he walks in a slow, mosey-like fashion. When he is standing for long bits of time; when he goes to move again the reluctance is obvious and his actions are slow and gauged. He is uncomfortable on both rear legs. often resting and shifting weight side to side. His legs do sound crickety now with arthritis when he starts moving after being stationary.

He was put on stall rest for 2 weeks w/ a daily short walk as it was believed he may have gotten rowdy outside and was just sore from his age. He was placed on a 3 day regimen of Banamine with no obvious improvements that were noticeable. After the first 7 days he was placed on 3 days of Bute with no obvious signs of improvement. He was somewhat back to his normal-self after the 2 weeks (bouncing around and some spring in his step but its hard to tell if that was improvement in the legs or just excited to be out of a stall).
The vet returned and did a full work up on him including flexion and balance tests but nothing conclusive other than he is old, arthritis is taking its toll and his slightly dropped pasterns are likely the contributing cause for his aches and pains at this stage. He also hoof tested him rigorously with absolutely no reaction and founder issues were once again ruled out of the equation.

The horse is on an MSM supplement and also a complete vitamin/mineral supplement for his age.
He has a very cushy mat to stand on in his paddock that he spends a lot of time on. I have contemplated building a sandbox in his run-in for added comfort but unsure if this would actually offer anything. It is understood he cannot stay on a banamine/ bute regimen long term and both drugs did not really take the pain away that were noticeable so they are bit of a non-option at this point.

The vet did not have much in the way of thoughts other than keep him on the joint supplement, and let him outside so that het can walk around and keep the range of motion going. He is outside and will walk around his paddock and graze and he is by no means just standing in a corner reluctant to move; but where he goes and how much effort he puts in is extremely calculated.

I have been linimenting the legs 1x a day each day for the past week. He seems revitalized afterwards and walks much better; but again, a temporary relief.

He is barefoot on the rears but wears shoes in the front. are regular-rear shoes an option to help him? Or will they offer him little support? Is there something else we can be doing externally to bring his comfort level back to something more desirable?

his sudden onset of discomfort is rather surprising to me, especially since his degree of drop to his pastern is not what I would consider lifechanging nor has he exhibited any severe range of motion discomfort in the past. There is another horse on the property that was a rescue and his also of similar age with severe DSLD that it has had for it’s entire life; yet it’s comfort level is much more desirable than this gelding whos onset was sudden. That horse is on a regular dose of equioxx. Equioxx could be an option for this gelding too, but unsure if it will do anything and the vet didn’t have a yay or ney on it either?

Overall the horse is in amazing shape for his age, he has held his weight and looks amazing and has always had amazing spirits up until a few weeks ago when he appears down. But his discomfort level has reached seriously concerning to me and I am hoping someone here has something beneficial I could try to help him improve.

@snaffle1987, I think that your vet is letting you down. I’m sorry that your horse is in pain and that you seem to have a vet that is not up on senior horse pain control.

I think that joint supplements are a waste of time and money at this point in time. Bute and other pain medicines will be much more effective (and probably less expensive than “joint supplements”) and will relieve his pain much more quickly. I think it would be best to bute him up and if that takes care of the pain, add whatever supplements you think will help him. If bute doesn’t do, it then try another NSAID.

Good luck. It must be very difficult to see your horse suffering. Just go with the proven, available pain medicines first, not supplements.

It’s difficult when what your vet recommends takes more time to relieve your horse’s pain than it should and stacking NSAIDS is dubious at best. You’re the advocate for your horse, so get enough of that bute or other NSAID from your vet to kill the pain now and think about other options after your horse is comfortable.

[little_sue]

We used Equicrown compression stockings on an older gelding with dropped front fetlocks. They also make them for hind legs. They brought him much comfort in his last year. They are NOT pull on. Some have zippers and some are hook and eye. We used the hook and eye. Easy on and off. Machine washable and right into the dryer. Yes, they can be worn in turn out. He could not have tolerated pull on compression stockings. The company is in Canada and ask for Donna. She is amazing and a very caring, compassionate horsewoman who will help you with the correct fit. Please call your vet first and get the OK. Our vet was the person who suggested Compression Stockings and we were so glad she did. Equicrown Compression Stockings, Canada, Fast shipping, Pricey,but, they honestly helped him and we felt so worth it. They have a Facebook page. All the best to you and your older guy…

[chestnutmarebeware]

IMO, old horses should be treated at the highest doses of painkillers without thought to long term effects of medications, because there is no long term future for them.

It’s like my vet who told me he didn’t care what my 19-y-o cat ate (KFC skin-on fried chicken) as long as he was eating, or the nursing home my elderly client lives in who lets the residents smoke (outside), because how is that hurting them in their 80s? At that age, who cares about any hypothetical damage?

I put my 16-y-o TB mare to sleep two years ago after three days of maximum dose stacked painkillers because they weren’t helping her cellulitis pain after it developed in her second hind leg. I could look at her and tell that life had become a burden, and it broke my heart but it’s what we do for our horses.

[IPEsq]

Putting a horse into kidney failure is a real, immediate risk with high doses of painkillers or stacking painkillers on a daily basis. It’s not quite the same as letting your cat eat KFC.

[chestnutmarebeware]

@IPEsq

Putting a horse into kidney failure is a real, immediate risk with high doses of painkillers or stacking painkillers on a daily basis. It’s not quite the same as letting your cat eat KFC.

I think that vets are the best judge of this. I don’t think they would prescribe the meds without considering this possibility and working closely with the owner.

And I know they wouldn’t condone inaction for weeks when the horse is in extreme pain.

I know I worked closely with mine, staying in contact every day.

[BigMama1]

@IPEsq

Putting a horse into kidney failure is a real, immediate risk with high doses of painkillers or stacking painkillers on a daily basis. It’s not quite the same as letting your cat eat KFC.

If the alternative is having them live in constant pain, or euthanizing them because of intractable pain, risking the side effects of painkillers is a reasonable approach.

Without the painkillers, the horse ends up euthed. If painkillers don’t work, the horse ends up euthed. If the horse goes into kidney failure, the horse ends up euthed. But if the pain killers do work and there is no kidney issue, horse regains comfort and quality of life and may enjoy several more good years.

[snaffle1987]

I was not going to provide an update but I suppose I will

He was only stacked on bute and equioxx for 2 days to relieve the immediate sudden onset of pain he was experiencing while we started the equioxx. It was not a long term plan; just immediate relief. He has now been off the bute for several days and is on the equioxx only with his regular daily dose of msm and his complete vitamin/mineral supplement. We are starting with a relatively low dose of equioxx to begin with; and will reassess in a little bit to see where he stand.

He is better. He is not normal but I think we are past the point of normal. But he is more mobile and willingly walking around his paddock , to and from his feeder, etc. He is happy and alert and spent the entire weekend walking around and enjoying outside. He has spending the entire day outside and has been coming in at night to a thickly bedded stall for rest.
We did find that if he was left outside for 24 hours he became drastically more uncomfortable. So the combination of inside rest + outside exercise seems to be helping. In recent years it is typically very wet this time of year and our herd typically spends a lot more balanced time inside and outside. This year it is extremely dry and they have been spending their time outside 24/7 on the hard, dry ground. Perhaps the amount of time he has been spending outside on the hard packed ground is contributing to this as it is not the typical “norm”

We did pull blood on Friday to check for tick borne disease/illness as it is becoming very prevalent here and from experiences in the past we have had similar symptoms (depressed attitude, stiffness, soreness). It may be a long stretch but we figured we better check just to be safe. His Cushings levels are also being reviewed.

We do know that we will likely have to increase the equioxx dose in the coming weeks but we are starting at a mid grade point and will work our way up if need be. I still have the bute on hand to use in as needed basis. There is an appointment with the farrier next week and we will assess any options at his visit to offer him more comfort and support

We are still approaching this with a very cautiously optimistic outlook. But the slight improvement in attitude and mobility in the past 4 days is a little more promising.

[snaffle1987]

thank you for your feedback. I will look up the Equicrown. He is a smaller horse on the scale, likely large pony size? I wonder if their products would fit his size legs. We have used the pull on compression socks in other treatment cases and I have to say, I HATED them. they fell down and rolled around the fetlocks and were just a nightmare. the hook and eye/zip sounds much better. thanks for the tip!

[endlessclimb]

I wasn’t aware there were “doses” of equioxx. I was of the impression that it was 57mg/day for an average horse, period.

Is your vet up to speed with all of this?

[snaffle1987]

He is on a half dose because he is in the neighborhood of large-pony size and slight of build. He is not a full 16.2/17.0 hand horse. If we were giving him a full dose right out of the gate; it would likely be an OD situation for the drug compared to his size and scale. My vet went to vet school and spent his entire life educating those in the veterinary field as well as treating horses of all issues; unlike you. I trust his judgment and approaching this situation with patience and caution.

[endlessclimb]

Righteo. You, and your 1/2g of bute a day for laminitis vet, have clearly got this covered. Enjoy.

(The Old Man Horse who has been on this stuff for 10 years is just barely 15hh and might be 950lbs if he’s lucky gets 57mg/day… so, still, no.)

It always surprises me how some people who seem so educated can be so… not. It forever changes my opinion of them…

[endlessclimb]

Just going to leave this here…

“The recommended dosage of EQUIOXX Tablets is one 57 mg tablet administered orally to horses weighing 800 – 1300 lbs, once daily for up to 14 days. For ease of administration, EQUIOXX Tablets may be given with food.”

[JB]

First - thanks for the update There’s a lot of learning to be had in all this (for everyone, and future everyones

@snaffle1987

He was only stacked on bute and equioxx for 2 days to relieve the immediate sudden onset of pain he was experiencing while we started the equioxx.

What was the dose of each? No judgement just honestly curious

@snaffle1987

We are starting with a relatively low dose of equioxx to begin with; and will reassess in a little bit to see where he stand.

What is “relatively low”? 57mg is a standard dose, akin to 1gm bute. I hope you’re not going lower than that. If it is lower, then combined with the other things like 1/2gm bute for 3 days and deciding it wasn’t working, I further seriously question what your vet is trying to accomplish.

I have seen Equioxx Rx’d at 114mg (akin to 2gm bute) for a short-term loading dose.

I say/ask that, because generally, you start with the highest dose to “load up”, find a relief point, and work your way down from there. That gets the most relief, the fastest.

@snaffle1987

He is better. He is not normal but I think we are past the point of normal. But he is more mobile and willingly walking around his paddock , to and from his feeder, etc. He is happy and alert and spent the entire weekend walking around and enjoying outside. He has spending the entire day outside and has been coming in at night to a thickly bedded stall for rest.

This is awesome

@snaffle1987

I still have the bute on hand to use in as needed basis.

The point has been made several times that stacking NSAIDs doesn’t really help lameness to a significant degree, while it does increase the risk of kidney damage. Some studies have also found bute more effective than firocoxib, though of course some individual horses disagree

[JB]

@snaffle1987

He is on a half dose because he is in the neighborhood of large-pony size and slight of build. He is not a full 16.2/17.0 hand horse. If we were giving him a full dose right out of the gate; it would likely be an OD situation for the drug compared to his size and scale.

Didn’t see this while making my last reply.

The dose for firo is 0.1mg/kg body weight. If he’s 800lb, that’s 364kg, which would be 36mg. That’s not far enough off a 57mg pill

If you’re giving 1/2 of a 56mg pill, so 28mg, then you’re missing the mark on a “full” dose. 3/4 would be more appropriate - 43mg.

“low” and “high” are not objective. They are relative to body weight.

@snaffle1987

If we were giving him a full dose right out of the gate; it would likely be an OD situation for the drug compared to his size and scale.

No. You keep missing the point. Dosing is based on weight. He SHOULD be getting a “full dose”. Maybe it’s not as many mg as a 1500lb horse.

57mg for 800lb is nowhere near an OD, not even long-term

But yeah, like endlessclimb said, the appropriate and safe and expected dosing of 57mg (1 tablet, 1 tube of paste) applies to an 800lb pony. You aren’t technically under-dosing if you give less than that, but it depends on what you’re actually doing - 1/2 a pill IS under-dosing.

And the point still remains - you don’t titrate UP in NSAID use, you use the highest safe dose to load up the body, get a circulating level high enough, and then you back down.

Your vet is dinking around and prolonging the level of relief your pony could be getting.

[Simkie]

So you’re nearly ten weeks in and don’t have a diagnosis? What’s preventing you from pursuing one?

[RhythmNCruise]

OP, give this old fella the full dose of Equioxx. He’s definitely not going to OD (did your vet tell you that???), and he’ll likely be much more comfortable. There is literally no reason to give him a half dose. None. It’s just preventing him from the full benefit of the medication.