Ringbone and Arthritis

A common problem to see in our equine patients is what is termed ringbone. Many may be familiar with this term, but unfamiliar with exactly what it is. Ringbone is essentially arthritis formation in pastern region of the front or rear limbs of the horse. To be even more technical, the ringbone is defined as either "high" or "low". High ringbone is arthritis associated with the pastern joint while low ringbone is associated with the coffin joint. Even further, it is delineated as either intra-articular (involving the joint) on non-articular (not involving the joint). Intra-articular ringbone leads to more pain development due to being involved with movement. In many cases, we will clinically diagnose non-articular ringbone in a clinically sound patient, which in most cases is more a cosmetic deformity or swelling in the pastern region. There are many causes for ringbone formation, which are: conformation, genetics, foot balance as well as injury to the region due to excessive use. I would like to demonstrate a few factors in a case involving a patient seen at our clinic. This is a 15 year old warmblood gelding that had a jumping career for the majority of his life.

This is the x-ray image of the RF digital region of the warmblood. Here we can see several things. First, we need to look at overall conformation or alignment of the phalangeal bones, which are P1, P2 and P3. P1 is the bone directly below the fetlock joint, P2 is the middle bone and P3 is the coffin bone which is held inside the hoof capsule. In ideal cases, all three of these bones are in alignment with each other at an angle, which is shown by the red line. As you can see, the bones don't correspond to this line, but essentially have a concave type of architecture in their alignment. This type of alignment leads to increased stress on the joint, which then contributes to joint damage. The arrow in the photo helps to point out the new bone formation or arthritis that has developed in the coffin joint and surrounding area. In this case, the ringbone is intra-articular as well as extra or non-articular.

Here is the x-ray image of the left front digital region. Again, here we have a red line which indicates more or less what the alignment of the three phalangeal bones should be. As you can see, in comparison to the other x-ray, in this foot, the bones are more closely in alignment with one another. However, there is rotation of the coffin bone, which is indicative of laminitis in the chronic sense. The white arrow indicates intra-articular ringbone formation in the coffin joint as well, but to a lower degree than in the left front foot. So, the question comes as to how to treat this patient and reduce his pain levels. In this particular case, we have opted to change the angles of his feet by trimming to help align the bones and change the angle of P3. One has to be careful in terms of trimming and changing angles because many of these guys have adapted to their current angles and the arthritis has somewhat "fused" the joint in that position. The pain that these horses feel comes from not only poor angles but also movement of the arthritis or boney spurs as he moves. In most cases, once the arthritis has bridged the joint and fused, the pain is reduced dramatically. The hard part comes in getting that joint to fuse. That is another story. Aside from trimming, he is being managed on low dose bute therapy once daily in conjunction with a special custom blend of our Cur-OST EQ Green product. He is also receiving initial doses of Adequan to aid in overall joint health. When he presented initially, he was a grade 4/5 in terms of lameness but within one week, he was more comfortable at a grade 2/5. I hope this helps to improve the understanding of ringbone in horses. Best, Tom Schell, D.V.M.

Cancer Thoughts

Cancer...the word is becoming all to common in today's society. Honestly, ask yourself how many individuals do you know that have or have been affected by cancer. In my world, that number is all too high given the number of clients that come in and out of our doors and that's not including those individuals that I am not aware of. I think the last estimate that I read was 3-4 out of 10 individuals are affected by cancer in some fashion. That is 30-40%, which may be a low estimate.

A couple of weeks ago, I had to report to my doctor for my yearly cancer re-evaluation. I was diagnosed with bladder cancer in 2006 and have been in remission since then. This would be year number 6 in remission if all went well. Those affected by cancer directly know what it is like going in for this annual or bi-annual examination. The fear, the worry, the sleepless nights the week before wondering what the findings would be. I have to admit that I do have one advantage in that I am able to evaluate myself throughout the year if I felt a problem was present. I had no problems the year prior and all my own testing was normal. I had no reason to fret, but yet I still did. Sitting in the lobby of the doctor's office was difficult as well as the time spent waiting in the exam room. The triage nurse had commented that my blood pressure was slightly elevated. Gee...I wonder why?
The funny thing is that I soon found peace as I was awaiting the doctor. How? I realized that we literally create what we fear. I changed my mindset and focused on a good outcome, which I knew was reality. The peace then followed and soon I was scheduling my next yearly exam with a clean checkup.

When I was diagnosed in 2006, it was a traumatic event for everyone involved in my life. I look at my diagnosis as a positive turning point in my life, which interestingly enough I am not alone in feeling this way. Many cancer patients report that their cancer diagnosis was a "wake up" call and a life changing event, resulting in positive outcomes on different levels. Out of everything bad comes something good. My change was that I realized how much emphasis I was placing on work and so little on my family. I realized how the stress in my life was impacting me physically and mentally. I realized that a change was in order. My diagnosis also led me to the development of our Cur-OST line of products, which were based on a formula that I developed to aid in my own recovery. We learn so much throughout our lives and I am just pleased to share what I have learned with others.

The topic of cancer is its own blog and too lengthy to get into here. There are a few interesting points that I'd like to make if possible. I encounter several individuals (humans) with cancer as they come in with their pets or horses. The one thing that I have noted with the majority of them is that their doctors are not discussing the importance of their overall health in their recovery. This includes diet, reducing environmental stressors as well as exercise. The patients literally feed off of every word their doctors says and follow their instructions explicitly. Too much is known about the influences of stress, poor health and poor diet on cancer development to ignore. The patients are exposed to deadly chemotherapy and radiation, but little is done to aid in that patient's recovery. It is sad to me to hear the patient's stories as they visit our clinic and my words of advice are often ignored. In end, no matter what your illness or diagnosis...I firmly believe that you have to be your own advocate in your treatment. Research your condition until you are exhausted. Investigate the treatments, their side effects as well as success rates. Look into alternative therapies and consider all your options.

We owe it to ourselves as well as those in our family to do everything possible to ensure our optimal health. I just recently discussed this topic with a client that was diagnosed with a form of lymphoma. I visited his farm to care for his horses and noted that he was not the individual I had remembered from the fall. He was winded and overall tired, not to mention pale. We discussed his condition and the fact that his doctors had attempted various treatments with no results. In the end, I believe he felt he was left with no options to improve his condition. He had made the comment that his doctors didn't seem to care or offer any suggestions. That is a tough pill for me to swallow as a caregiver myself.

I hope and pray that cancer has not affected you, but if it has, think things through. Do you have thoughts on cancer?? I'd love to hear them. Email me!

More thoughts on cancer to follow...

Yours in health.

Tom Schell, D.V.M.
tschelldvm@gmail.com

Everyday Inflammation

If you watch the nightly news at all here recently, I am sure that you have heard the latest research findings behind the protective benefits of aspirin not only against cardiovascular disease but cancer as well. The findings that various NSAIDs, aspirin included, actually decrease the incidence of cancer have been around in human research for a while now but here recently have just made the national news. Not sure why this is, but it seems that research findings actually take a while to make it the status of public knowledge. A shame actually, as many could have possibly benefited over the past few years. In any case, the question comes as to how aspirin could decrease the incidence of various cancers?

Inflammation is actually thought to be at the root of the aspirin intervention. The concept of inflammation being a major component of many forms of cancer has been known for a while now. It appears that many types of cancer have an up regulation of pro-inflammatory proteins or cytokines, that help to encourage the right conditions that foster cancer promotion and progression. The concept of inflammation is also tied into cardiovascular disease as well as strokes, thus the benefits of aspirin.

This brings up the whole concept of inflammation, how it comes to be and how it impacts us and our animals overall. Inflammation is a very complicated topic and beyond the scope of this blog, but is an ongoing process in our bodes as well as that of our animal companions. Inflammation is the result of exercise, the process of breathing, diet, environmental influences, various medications as well as even the mindset. The overall point is that this process exists to varying degrees in individuals and animals, but needs to be monitored and controlled.

In our veterinary patients, the inflammatory condition is rampant from my point of view and manifests in various problems ranging from repetitive injuries, to skin conditions, diabetes or insulin resistance, arthritis, laminitis as well as ocular problems. Unfortunately, monitoring the process of inflammation is difficult and does not have a parameter that can be monitored routinely. Various research studies have parameters that are measured, but these are not easily tested in the real world of medicine. At our practice, we can monitor oxidative stress levels, lactate levels as well as insulin levels in various patients to gain a better perspective of inflammation.

In the end, we have to assume that inflammation may be present in a chronic form in many of our patients, especially if there is a chronic disease that we are treating. The question of treatment then comes into play, which raises the point about aspirin. Many NSAID medications have shown potential to decrease the incidence of inflammation to varying degrees. The problem with most NSAIDs is that there are potential side effects and they are not for every patient due to interactions with certain exisiting medical conditions. Given this, we must rely more on diet and herbal therapy from my perspective. Research has shown the ability of various herbs; including curcumin, boswellia and ashwaghanda to both reduce inflammation and the incidence of certain cancers, all with minimal to no side effects.

The take home point is that many of today's diseases are linked with chronic inflammation and thus potentially treatable or at least manageable. As the saying goes, "an ounce of prevention is worth a pound of cure".

Food for thought.

Tom Schell, D.V.M.