Severe Cartilage Degeneration in a Horse

A 12 year-old show jumper mare presented to PHD veterinary services for the history of recurring forelimb lameness. In the past 2 years, the mare had the left front coffin joint treated with corticosteroids and hyaluronic acid every 6 months. However, the most recent treatment with intra-articular corticosteroids did not result in resolution of the lameness. On presentation, the mare was a grade 3/5 lame in the left front. The lameness was most evident when trotting on firm ground and in a circle to the right. The mare was NOT positive to hoof tester exam and was mildly positive to lower limb flexion. The coffin joint was "blocked" with carbocain and the mare's lameness improved by >85%. Radiographic exam of the left front foot only revealed evidence of mild osteoarthritis of the coffin joint.  (Figure 1).

Figure 1

Due to the following factors: 1) a history of poor response to intra-articular therapy, 2) a positive response to blocking the coffin joint, and 3) minimal data via the radiographic exam, it was recommended that the distal forelimb of this mare be evaluated via magnetic resonance imaging (MRI).  The MRI exam requires general anesthesia and generally costs between $1800-$2000; however the information gathered from an MRI exam is far superior than any other type of diagnostic exam! As such, I strongly recommend considering an MRI exam in cases that the CAUSE for the lameness has not been determined and a reasonable attempt has been made to treat and/or diagnose the problem. Figures 2-4 includes several images from the MRI exam involving this show jumper mare. A small, blue circle is included in each image to high light the large articular cartilage and subchondral bone defect that was discovered through the MRI study. In each image, the lesion appears as a small black circle at the surface of the bone. In addition to this finding, the MRI study noted additional evidence of chronic degeneration of the coffin joint. The full extent of the degeneration and the cartilage damage was NOT evident in the radiographic exam!!

Figure 2

Figure 3

Figure 4

Although the prognosis was poor for return to soundness, the mare was treated aggressively with various regenerative therapies and extended rest. Unfortunately, the mare remained significantly lame and it was determined that humane euthanasia was the best option due to the relentless foot pain. A post-mortom exam was performed and a very large area of abnormal cartilage loss (blue circle in Figure 5) was noted that corresponded to the MRI findings. This case represents yet another exam of the importance for getting an answer as to WHAT is causing the problem such that a prognosis can be provided followed by a proper course of action.

Figure 5

In the state of Florida, the most sensitive MRI for imaging in horses is ONLY available at the University of Florida's College of Veterinary Medicine. In addition, the board certified radiologists at the Veterinary College of Veterinary Medicine are especially well trained for the evaluation of MRI studies in horses! For more information about their services please go to:

http://largeanimal.vethospitals.ufl.edu/services/diagnostic-imaging/

Urinary Bladder tumor in a Horse

A 12 year old gelding presented to PHD veterinary services for the complaint of "dribbling" urine and intermittent bouts of urinating blood (hematuria). The horse had been treated with a combination of antibiotics and steroids which had resulted in resolution of blood in the urine however he continued to dribble urine. On presentation the physical exam was normal other than evidence of chronic urinary incontinence based on the accumulation of dried urine over the dorsum of both hind limb pasterns. A rectal exam was performed and a softball-size mass was palpated within the urinary bladder.

Figure1

Figure 2

Cystoscopic exam noted several small soft tissue masses leading into the urinary bladder with evidence of active, mild hemorrhage (Figure 1). Once the urinary bladder was entered with the scope, a mass was noted lying underneath the urine that was present in the urinary bladder (Figure 2). The urine was evacuated through the scope revealing a large, soft tissue mass that was firmly attached to the ventral or bottom aspect of the urinary bladder (Figure 3 and 4).

Figure 3

Figure 4

Urinary bladder neoplasia or cancer is rare in horses. The most common common type reported in horses is squamous cell carcinoma and it commonly associated with hematuria. Other types of cancer include transitional cell carcinoma, lymphosarcoma, leimyosarcoma and fibrous polyps. Management of urinary bladder neoplasia in horses involves surgical resection and possible intra-lesional chemotherapy; however the prognosis is poor for long term survival. This horse will be managed with systemic anti-inflammatory medications to reduce local inflammation within the urinary bladder and the proximal urethra.

Superficial Flexor Tendonitis in a Horse

A 12 year old mare presented for sudden onset forelimb lameness and swelling of the tendons in the right front limb. On palpation, the swollen tendons were significantly sensitive to palpation yet it was not possible to determine if it was the superficial flexor tendon (SDF) or the deep digital flexor (DDF) tendon. The mare was a grade 3/5 lame in the right front when trotted in a straight line on firm ground. Ultrasound exam of the soft tissue structures revealed a core-like lesion within the outside corner of the SDF tendon. In Figures 1-3, the core-like lesion appears as a black area (red circle) within the body of the SDF tendon (blue circle).  In Figure 2, the image to the right is a cross-sectional view of the tendon and the lesion is a small black circle within the body of the SDF tendon. In the image to the left in Figure 2, the tendon is in a longitudinal view and the lesion appears as a black streak through the body of the SDF tendon.This view is important because it highlights the over-all length of the lesion which in this case was 4-5cm long. The cross-sectional area measured in Figure 3 determined that the core-like lesion was approximately 20% of the entire cross-sectional area of the SDF tendon.

Figure 1

Figure 2

The mare was treated with ultrasound guided injection of Platelet rich plasma (PRP), stall rest, daily ice therapy and we will follow-up with 3 doses of extra-corporeal shock wave treatment. We anticipate a full return to work after the appropriate period of rehabilitation.

On-Line Pharmacy for PHD Veterinary Services!!

 

The above medications are just a few of the hundreds that my clients will be able to purchase via my on-line pharmacy!! The pharmacy will be open for business within the next 2 weeks and can be accessed at the following address:

PHD Veterinary Services On-Line Pharmacy

Once open for business, my clients will be able to register their pet's information and order the medications desired. I will receive an instant email to confirm authorization for the sale of the medications and the client will enter their credit card information. This pharmacy will contain hundreds of medications and nutraceuticals for cats, dogs, and horses! Once ordered the products will ship direct to my clients for quick delivery.

I anticipate that PHD Veterinary Service's on-line pharmacy will offer my clients an efficient and affordable method to purchase prescribed medications for their cats, dogs, and horses. There will be monthly sales on some of the more popular products so please visit my blog site to find out when the pharmacy is open for business!! Please visit the on-line pharmacy today and register your cats, dogs, and horses!