pain b&b

So. The experiment of last week.

When I took a lesson with Tina in May, I was starting to think about joint maintenance and preventative health.  Or maybe treatment.  Or …. whatever was appropriate.  I asked her thoughts, told her that I wasn’t looking for trouble/to spend money, but, you know, maybe the time had come to inject something?

Tina suggested, very practically (and, I should note, as a DVM), that I could try giving Murray what she calls a “B&B cocktail” for three days to see if it improved anything.  The B&B cocktail being 1g of bute and 250 mg of banamine twice a day.  If there was pain or inflammation somewhere in Murray’s body, the NSAIDs would mask them during that time.  If Murray was better on drugs, then we would know that he likely needs to be injected somewhere.  If he wasn’t… I’m not really sure what the logical conclusion to that would be.

So I put my horse on a pile of NSAIDs and a little bit of ulcer prevention on Tuesday of last week. And boy, did it ever tell us anything.

oh look, those hocks actually bend…

During last week’s lesson, Tina commented immediately that Murray looked great, that he was moving his hocks and his back really well.  This is a comment we don’t usually get until we’ve worked through all the residual stiffness, about halfway through a lesson.  Every exercise we did in the lesson was easier for Murray than it usually is — and it’s not like we’d been practicing a bunch either.  I jumped on him for the first time in a week for that lesson, and he was fantastic. Collecting the canter was so shockingly easy for him when I asked.  The difference was very, very clear.

My Friday  jump lesson was also “on drugs”, though we were coming down from them at the time.  Murray’s last dose of NSAIDs had been that morning right before the lesson, and he’d gone 24 hours between doses, so he probably wasn’t feeling as good as he had during the previous few days.  That, too, might have contributed to his nappiness.

just asking for a little more trot here

vs.

actually going for the extension here

I’ve actually already had the vet out to do Murray’s hocks (since this all took place last week) — I piggybacked on someone else’s PPE appointment.  It will be very interesting to see how it turns out, and whether this actually makes him more comfortable.

cantering on drugs last week

vs.

cantering off drugs

I’m more than happy to include hock injections as part of Murray’s routine maintenance.  He’s proven to me that he’s worth investing in (lol, only took four years), and obviously from a welfare and ethics standpoint I want him to be comfortable in the work we are doing.  I fully acknowledge that we ask horses to do some pretty unnatural things, though, and that some low level of discomfort is likely to be present in doing this.

camelot, june 2017

vs.

during the experiment, last week
not a totally fair comparison as it’s not quite the same moment of the stride, but you get the idea

But I also don’t have the funds to endlessly pursue what might make him feel better if the hock injections don’t help.  It seems like there are a lot of ways I can spend, validly or wastefully, money on this “problem” — and part of it depends on how big I decide the problem itself is.  There are plenty of horses who are comfortable competing at much higher levels than we with similar (or even more) maintenance needed.  Honestly, I’m hoping that this does the trick enough for me to be able to put thoughts of further evaluation and injection out of my mind.  At least until I develop that app and become a grillionaire.

may 2015

january 2017

during the experiment, july 2017

The key will be to keep evaluating Murray’s comfort and happiness in work.  Formerly, Murray’s objections to work always seemed to be to the concept of work in general, which I have always taken as a work ethic problem.  He’s always had a kinda shitty work ethic (but maybe he’s also always kinda needed some more joint support?).  So the next few months will be very telling for us.

reconsidering pentosan

Since Twin, I’ve been thinking about what I might be able to do for Murray to make him more comfortable and extend our competition career.  A part of what inspired me to start thinking about it more seriously was his super-stardom at Twin, but I also have a lot more income than I ever have in the past. This makes entertaining the idea of spending/potentially wasting money on my horse’s well-being possible — I literally* did not have the money to pour money into joint maintenance before.

* The actual literally, not the millennial “literally” that really means “figuratively” or “maybe”

I first heard about Pentosan on Amanda’s blog (like, where I hear about most things apparently), and after following the trail of evidence she left, I wasn’t terribly convinced.  Use of the drug was based mostly on anecdotal reports of improved movement and comfort after IM/IV injections among Australian horse owners, and there wasn’t a ton of peer-reviewed evidence to back up using Pentosan IM/IV for joint maintenance.

murray is a skeptical walrus

Pentosan, if you’re unfamiliar, is a semi-synthetic polysulfyated xylan (don’t know what that really means? me neither!).  It is used for several purposes, including treatment and prevention of osteoarthritis.  The most interesting thing, to me, about pentosan is that it is used during open-joint surgery to help heal the joints after they are put back together.  Literally, surgeons squirt the stuff all over the open joint to help avoid cartilage break down and improve synovial fluid viscosity.  edit: Austen pointed out to me this important clarification: joint lavage (which is done both surgically or arthroscopically) works by helping to wash away debris that accumulates in the joint and may cause pain (at least in humans).  Therefore, the pentosan may not be having as much of an effect as might be reported — the lavage process itself is extremely helpful in this case.

I’m won’t rule out a treatment or medication as ineffective simply because it doesn’t have veterinarian or peer-reviewed evidence.  I know that it takes time to conduct studies and gather data, and that what is currently being studied may not be what is in vogue with horse owners at the time.  Joint pain and comfort is terribly hard to quantitatively evaluate, especially when you want to look at more than just the articulation of a specific joint (how far that joint can flex/bend), and supplements/drugs for joint pain in companion and production animals aren’t necessarily at the top of the research ladder.  Particularly in equines, the amount of scientific inquiry into the efficacy of drugs or supplements is quite sparse.

All that said, I’m not going to rush out and spend a lot of money on a product that is anecdotally reported by horse owners to make their horses “feel better”.  The placebo effect*, even among animal caregivers and owners, is a real thing.  (Also in 2014 my horse was five, not actually mine, and it wasn’t the time to think seriously about maintenance.)

* Have just realised this could make an incredible horse name!!

placebo effect is sooooo good at canter poles

When I started thinking about and exploring joint maintenance for Murray this year, pentosan popped up both on the interwebs and at the suggestion of a friend.  I took some time to look into the drug more seriously, and found that in the last three years, enough evidence about the efficacy of pentosan in prevention and treatment of OA has accumulated to convince me it’s worth a try.  If you’re interested in my research, just hit me up and I can share the details with you.  But here are some of my more general findings.  (Links here may be behind a paywall.)

First of all, pentosan appears to be safe to use in  horses both intra-articularly (i.e. joint injections), as well as IV and IM.  That’s great, because it means that you don’t have to pony up for expensive IA injections just to get the drug, an if you can’t do IV, you can safely go IM.

There is also good evidence that IM pentosan actually makes its way into both the plasma (blood) and intra-articular spaces (joints).  And in dogs, pentosan has been used to successfully treat chronic osteoarthritis.  If you want to dive a bit deeper into the cell-biology literature (exposing oneself to some serious jargon at the same time), there’s at least one proposed method for pentosan to treat osteoarthritis by acting as a chondroprotective agent (cartilage protective agent).

unrelated puppy throwbac pic

Pentosan was demonstrated to modify the healing of experimentally-induced OA in donkeys and horses.  In these studies, donkeys and horses with experimentally induced OA were given IV pentosan (treatment) or saline (control).  At the beginning of the treatment period, all animals were lame, and their levels of lameness, synovial fluid, cartilage damage, and the levels of certain elements (Mg, Ca) were tracked over time (among other factors associated with joint health).  All of the above mentioned factors improved significantly in treatment animals, i.e. synovial fluid was decreased compared to controls, cartilage damage was less.  Most importantly to me, lameness score in treatment animals decreased to baseline (which I believe was 0) after pentosan treatment, whereas in control animals lameness score decreased, but never achieved baseline levels.

Certainly, this is a pretty extreme way to check the utility of pentosan.  And it doesn’t necessarily speak to the maintenance side of the drug, or how pentosan interacts with joints that might have mild-moderate OA. Notably, a similar study using pentosan and hyaluronic acid was inconclusive and demonstrated no improvement with treatment.  So there is still plenty of room for skepticism.  However, if the proposed relationship between increased synovial fluid and cartilage degeneration in osteoarthritis is correct (an extremely reasonable and supported assumption), and pentosan really does decrease synovial fluid and help decrease cartilage damage, then it seems reasonable that pentosan may help prevent or mitigate osteoarthritis (by mitigating cartilage damage and preventing the forces that result in increased synovial fluid).

There are still lots of “ifs” here.  But I’ll definitely be talking to my vet about pentosan in the coming weeks.

shut up and take my money