Navicular--is it the kiss of death? Help!!!

[Tom_Stovall_CJF1]

Originally posted by LMH:
Hoping I am not repeating a topic already discussed…I am just trying to catch up here.

If I understand correctly (sometimes it is easier, to quote Denzel Washington, explain it to me as if I were a 6yo), you would “normally” (obviously exceptions to every rule) treat a navicular horse by elevating his heel height…ala wedges.

<span class=“ev_code_RED”>In my experience, long and lows diagnosed with navicular syndrome respond immediately and favorably to wedges and other forms of heel elevation (esp., various moldable prosthetic devices) provided the bearing surface of the heels can be increased sufficiently. All else being equal, slapping a wedge under a horse that has run under heels is a recipe for crushed heels unless the aberrant growth is removed. New growth follows old.</span>

Are you familiar with Dr Bowker? And his “recent” conclusions regarding navicular pain in horses? Obviously if you are either not familiar with him, then that needs to be first addressed…

<span class=“ev_code_RED”>Yes’m, I try to keep up.</span>

If you are and do not respect his findings, I am curious as to why…specifically what incorrectness do you find in his work (for others reading, he has advocating not wedging horses for navicular and has even found success in relieving the pain through barefoot).

<span class=“ev_code_RED”>In reality, Bowker he has made a series of observations and formulated a hypothesis (aka, “SWAG”) in order explain what he observed without attempting to confirm his hypothesis by testing, publication and peer review. When Bowker’s observations include horses in use and his recommended protocols enable horses in use to be returned to service on a timely basis, his observations will become relevant to pragmatic farriery.</span>

[Pocket_Pony]

Having been reading a lot about barefooting these days, Jaime Jackson says (what else?!) that pulling the shoes and doing a “natural” trim will help the “navicular” horse (in quotes because he doesn’t seem to believe that is a separate disease from laminitis, I think). So there you have it, FWIW. I have no experience with that and all the remedies I’ve heard of are the traditional bar shoes, pads, wedges, medicine, etc… I can’t speak frome experience either way.

[Bea]

cyberbay, I read this article not long ago. Have no idea if it’s possible to look into it for your horse, unfortunately it appears the best chance for these injections to help is early on in treatment. And, probably as you found out from the info posted above, I would imagine it would depend on exactly what aspect of navicular syndrome your horse is experiencing as to whether the below would be relevant. But thought I’d pass it on, might be difficult to find a vet who’s familiar with its use. If I understand this correctly, the drug is not approved for use with horses in the US, so if used it would be off-label usage.

Treating Navicular Disease From Inside the Bone
by: Susan Piscopo, DVM, PhD
July 2004 Article # 1527

Article Tools

Healthy bone undergoes constant metabolic change to prevent bone loss or abnormal remodeling (cell turnover) that can occur with loading. Horses with navicular disease can have abnormal remodeling and formation of osteolytic lesions (areas of broken-down bone) within the navicular bone. This might be due to an imbalance in bone metabolism, with increased bone resorption. Dominique Thibaud, DVM, of Ceva Santé Animale (CEVA), in Libourne, France, with colleagues in France, Italy, and Germany, set out to evaluate a drug to target abnormal bone metabolism. The drug, tiludronate, inhibits excessive bone resorption, allowing bone metabolism to become balanced once again. The study aimed to assess tiludronate’s effectiveness against navicular disease. (The drug is not approved in the United States for use in horses, so any clinical use would be considered off-label).

Fifty horses with moderate to severe navicular disease were studied. Radiographs and videotaped lameness examinations were collected prior to treatment. Horses were randomly assigned to receive either 1 mg/kg tiludronate intravenously (IV) daily for 10 days; 0.5 mg/kg IV daily for five days, followed by five days of placebo; or 10 days of IV placebo. Lameness exams were performed (and videotaped) one, two, and six months after treatment. Radiographs were repeated six months after treatment, and independent examiners reviewed all radiographs and lameness exam tapes. Horses which didn’t respond to tiludronate or the placebo by two months, based on clinical examination and owner evaluation, were removed from the study as treatment failures and treated as needed with tiludronate.

Horses responded best (based on improvement of lameness and ability to return to work) to the regimen of 1 mg/kg tiludronate IV daily for 10 days. More recent cases of navicular disease (less than six months duration, 33 horses, no treatment failures) responded better than chronic cases (17 horses, 11 treatment failures). Of recent-case horses, 67% showed a positive response to treatment, and 75% returned to normal activity by six months.

Interestingly, horses had no change in flexion/extension test response after treatment. However, Thibaud notes, “Flexion/ extension tests assess local pain of the coffin joint, which can be due to both soft tissue and bone lesions. Tiludronate acts specifically on osteolytic bone lesions.” So, some pain can remain in the foot despite improvement in the navicular bone. Overall, the results support Thibaud’s opinion, “Tiludronate helps in restoring a normal balance between resorption and formation of bone” in horses with navicular disease. However, drug therapy should be combined with corrective shoeing for best results.

Thibaud is currently studying bone pharmacology in horses and other species. The CEVA web site (www.ceva.com) has prepared a link to a separate web site devoted to tiludronate, or Tildren, for horses at www.tildren.com.
Denoix, J.M.; Thibaud, D.; Riccio, B. Equine Veterinary Journal, 35 (4), 407-413, 2003.

[Tom_Stovall_CJF1]

In response to one of my essays, someone wrote:

“There is no pressure on the navicular bone from the DDFT. In fact the more weight the horse applies to the foot the further the DDFT is pushed away from the bone. Therefore there is no reason to expect these recommendations to work, since the problem is misunderstood - backwards…”

This statement will come as a great surprise to the folks who’ve labored mightly to teach me a bit of equid anatomy over the years. Every one of them - as well as the authors of standard classroom textbooks such as Stashak’s, “Adams Lameness in Horses” and Butler’s, “Principles of Horseshoeing” - seemed to think that the deep digital flexor tendon originates on the flexor muscles and inserts on the semiluner crest of the third phalanx and adjacent surface of the collateral cartlidge of the third phalanx. The DDFT uses the navicular bone (aka, distal sesamoid) and proximal sesmoids as fulcurms.

The flexor muscles transfer their energy to motion through the action of flexor tendons on bone. The DDFT is the largest of these tendons and uses several fulcrums on the bony column to increase the muscles’ ability to transfer energy through leverage. Archimedes at work!

Since the navicular bone is used as a fulcrum by the DDFT, it follows that contraction of the DDF flexor muscles must place the navicular bone in some degree of compression. Furthermore, physical law dictates that the more acute (lower) the phalangeal angle, the greater the amount of compression. Put another way, if one whacks of the heels off a horse with navicular syndrome as advocated by the current crop of “natural” folks, one unarguably places the navicular bone in greater compression.

Since several forms of navicular syndrome are both insidious and incurable, palliation by some means is often the only viable mechanical option on diagnosis of NS if the horse is to remain in use.

[LMH]

Lookout I missed this question from you…KC showed up for one post in this thread:

http://chronicleforums.com/groupee/forums?a=tpc&s=6656094911&f=5206053911&m=619209763

[Lookout]

I know you’re not talking to me, but I’ve often wondered what in Bowker’s work constituted “research”.

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by LMH:
LOL-it appears we have posted at the same time and reached the same conclusion.

I do however have a “follow-up” question or statement…are you saying Bowker just had this idea and has no real case studies to prove it…and this is the basis of his publications?
He never tested his lower the heel idea on any horses? <HR></BLOCKQUOTE>

[Bea]

IndysMom, you and I were posting at the same time. If your guy is recently diagnosed I wonder if the article I posted might apply. Let us know if you decide to ask your vet about this French drug study, and what they say.

[Robby_Johnson]

Well look what the cat dragged in! It’s about time!

Welcome to the Chronicle buddy! Thank you for all of your sage advice. Where farriery is concerned, you truly raise the bar in education for all horse-owners.

Robby

[slb]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by Txfarrier11:
I know Tom , as I did Burney and if you want to call them egotistical, go ahead. Both have been friends and mentors to me and I havent found this to be true.
Tom is , as Burney was, pretty plainspoken, with little use for things that havnt been proven to work as opposed to things that have.
I guess you could mistake that for egotisim but I feel its more impatience with people that want to believe theorys are facts. <HR></BLOCKQUOTE>

I never said any such thing…
I simply implyed that egos run high when it comes to whose right and wrong on these subjects. I was noting Chapman’s agreement of this…not calling him egotisical.

There is plenty of “proof” that the things I mentioned work. There are plenty of farriers out there applying the principles that I mentioned and there is plenty of “cutting edge” (read that 10-20 year old) research to back it up.

What I see in this discussion is that if we don’t agree with Mr. Stovall, then we are lunitic-fringe, die-hard barefooters. I never even mentioned barefoot as a treatment…I only disagreed with permanent wedging. How does that make me fit into his “one-size-fits-all” catagory of “inexperienced fanatics”?

And…if you are looking for proof of what works, then I would be happy to supply you with the cases studies that back my statements of success.

[Tom_Stovall_CJF1]

[Deletia in places, attributes in jeopardy, apologies in advance]

<span class=“ev_code_GREY”>
Like many folks long on theory and short on experience, your obvious inexperience renders you unable to separate the wheat from the chaff when it comes farriery. I read the textbooks and journals, not the vanity publications and advertisements: Perhaps you would do well to do the same.</span>

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>
While I admit to inclucing the “vanity publications” in my reading…as I look to expand my mind and explore all venues open to me…my base of knowledge comes from the same books that yours does, I simply kept reading and didn’t turn off the light after I read the standards.
<HR></BLOCKQUOTE>

Therein lies the difference between you and I. What I know of farriery is based on both education and experience in the real world; your lack of the latter is painfully evident.

<span class=“ev_code_GREY”>To paraphrase Guy Clark, I’m a big fan of stuff that works.</span>

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>
Are you?
<HR></BLOCKQUOTE>

Yes’m, stuff that works is what separates folks like me from folks like you.

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>
I guess that we would agree here…unless our definitions of what “works” is different from my expectations.
<HR></BLOCKQUOTE>

Not being clairvoyant, I have no idea how you define the term. I define “stuff that works” as the application of whatever farriery is required to enable a horse to do whatever it does without pain.

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>
Can you say that you have successfully restored at least 95+ percent of your charges to soundness without continued reliance of therapeutic devices?
<HR></BLOCKQUOTE>

That sound your hear in the background is the unrestrained laughter of a multitude of farriers, veterinarians, and assorted horsemen who find your statement to be utter mendacity. Assuming horses in use presented unsound, no one on the planet with any sizable custom has returned 95% of those horses to being sound for service without total or partial reliance on various mechanical therapeutic and palliative therapies.

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>
To me a decade of this type of work speaks for itself.
<HR></BLOCKQUOTE>

Your claim is certainly eloquent, but it says more about your woeful lack of experience and willingness to make pie-in-the-sky claims than your ability to heal the halt and lame.
I don’t make any such claims, but I have helped to return one or two horses to service by mechanical means. For a bit of insight into my personal philosophy, including my misspent youth, please see
<http://www.katyforge.com/better’n_drugs.htm>

[slb]

Cyberbay…Did you actually see your horse born this way? I am curious as I have never heard of this. In some schools of thought it is considered that congenital club foot would be found on two feet, either fronts or backs. However, from my experience one up, one down is a creation of poor trimming or lack of trimming.

[LMH]

Tom-while you are here…why don’t you drop by this thread and do a little good for someone:

http://chronicleforums.com/groupee/forums?a=tpc&s=6656094911&f=5206053911&m=572208273

She is having some foot questions and perhaps we could all learn from a professional in the field commenting on the newly shod feet.

[Txfarrier11]

I know Tom , as I did Burney and if you want to call them egotistical, go ahead. Both have been friends and mentors to me and I havent found this to be true.
Tom is , as Burney was, pretty plainspoken, with little use for things that havnt been proven to work as opposed to things that have.
I guess you could mistake that for egotisim but I feel its more impatience with people that want to believe theorys are facts.

[Tom_Stovall_CJF1]

Originally posted by LMH:

[deletia]

Take underrun heels for example-add a wedge and horse is short term sound-but even by your own admissions long term use of wedges will in fact further crush the heels causing more complications…

<span class=“ev_code_RED”>The addition of a wedge pad or prosthetic material to a bearing surface that has been increased sufficiently in area does not have the effect of crushing the heels, quite to the contrary. In my experience, the procedure can be both expensive and labor intensive, but it enables a horse to be kept in use without ill effect.</span>

SO client has huge competition, you are her new farrier–waddya gonna do? Tell her this will take you one year to repair or put the wedge on and deal with it later?

<span class=“ev_code_RED”>With respect, your statement is a logical fallacy because it demands a single answer when several are possible. Please see above for another possibilty.</span>

[LMH]

Well Tom, I must say I have enjoyed our back and forth-but I do think we have said what needs to be said for the purpose of this thread…time and testing.

Hoped you enjoyed it as well.

[LMH]

Hoping I am not repeating a topic already discussed…I am just trying to catch up here.

If I understand correctly (sometimes it is easier, to quote Denzel Washington, explain it to me as if I were a 6yo), you would “normally” (obviously exceptions to every rule) treat a navicular horse by elevating his heel height…ala wedges.

Are you familiar with Dr Bowker? And his “recent” conclusions regarding navicular pain in horses? Obviously if you are either not familiar with him, then that needs to be first addressed…

If you are and do not respect his findings, I am curious as to why…specifically what incorrectness do you find in his work (for others reading, he has advocating not wedging horses for navicular and has even found success in relieving the pain through barefoot).

[Posting_Trot]

You could also look at the bulletin board on the professional farriers’ website: www.horseshoes.com . There are a set of BBs dedicated to farriers answering questions from horseowners, and you’ll find some very good discussions of navicular and various treatments there.

[Bensmom]

Since I don’t understand in any way how lowering the heel could ever help a NS horse and I will admit that I haven’t read any of the literature that suggests it will, my question isn’t directed at that part of the discussion but I wondered about this:

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR> Frog pressure in NS horses is contraindicated in every text from Lungwitz to Stashak and its immediate, deleterious, effect is readily demonstrable. I guess it’s a case of, “Who am I going to believe: the ‘research’, or my lying eyes?” <HR></BLOCKQUOTE>

If you don’t want any frog pressure in a NS horse, then why does it help to use the equi-pak poured pads in one? We’ve got one horse that is actually diagnosed with NS in my barn that has been poured since the diagnosis was made and I’ve seen farriers use it to make these horses more comfortable.

It would seem, per the statement above, to be the absolute wrong thing to do though, since it loads the sole and frog with pressure, though the pressure is evenly distributed.

Thanks,

Libby

[Ghazzu]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by slb:
For example, Dr. Lewis…“father of protein caues problems in growing horses”…has long since retracted his negative statements about protein, but it still remains in univeristy texts and is still taught in the classroom. It is generally agreed that vets are coming out of school at least a decade or more behind the research. <HR></BLOCKQUOTE>

Whoinhell is still teaching that?

As far as “generally agreed”, by whom?
Neophyte DVMs may leave the classroom behind the cutting edge in some areas, but it is the faculty members at their schools who are doing most of the research

[Bea]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by Tom Stovall, CJF:
Please understand that if the DDFT is <span class=“ev_code_RED”>not</span>connected the flexor muscles, then it will not place the proximal sesamoids or the distal sesamoid in compression when the joint is flexed; however, in a living horse, absent some catastrophic event, when the flexor muscles are flexed, the DDFT places the sesamoids in compression. <HR></BLOCKQUOTE>

As a complete amateur bystander, that makes sense to me. That one piece of the mechanism can not be looked at independently. But of course I’m more than willing to be bribed over to the other team.

Can’t, hasn’t, someone done a 3D computer model of a horse? One you could lower the heels on, raise the heels on, and so, in order to judge the effects on soft tissue etc. I’m sure I’ve seen human computer models on Discovery channel programs. I’d be more than willing to donate $5 or so to develope one, if it would ease the bickering. Dutch, maybe you could put your navicular vaccine on hold and program a nice computer horsie instead?