The pelvis at the right was photographed at the Wild Horse Sanctuary. You can clearly see the iliac wings.  The sacroiliac joint (SIJ) is a paired joint on either side of the pelvis where the sacrum articulates with the iliac wings of the pelvis. This region is a common factor in upper hindlimb lamenesses, particularly in racehorses and sporthorses, and has been the focus of recent study for better diagnosis and treatment.

 

If your horse is showing hindend discomfort, or is unable to pick up or maintain canter leads, cannot engage, or bucks or rears under saddle, the SI region may be to blame. Often a diagnosis of soreness can be made by palpation, but an ultrasound examination to check the structure of tendons and ligaments in the area is important. Nuclear scintigraphy, where a radio-opaque dye is injected and then has increased settling in "hot" areas, can also be useful. However, studies have shown the the thickness of the skin overlaying the joints, and urine in the bladder may actually obscure these results.

 

Racehorses are prone to SI problems, as well as any horse that must engage this joint under significant pressure- the Grand Prix jumper, or the dressage horse under extreme collection. Horses that slip in pasture, or put a hindleg in a hole can also have tears or problems in this area.  Stand behind your horse and look at his butt. Are the muscles even? Can you groom and rub here without your horse getting upset? Does he have any problems lifting his hindlegs for the farrier?

 

What can be done? Changes in the SI joints may respond well to injection. Ultrasound-guided injections are most reliable, though some practitioners may do "blind sticks".  The injections are like hock injections, aimed at reducing pain and inflammation, and increasing overall mobility.  Acupuncture, particularly electroacupuncture, is very useful for sacroiliac pain or mobility problems. And Chinese Herbal support such as Body Sore, Hindend Weakness, Equine Du Huo, may also be helpful.

 

 

Last month we looked at the 5 element theory and personality constitutions. Chinese medicine employs a different patient work-up than western medicine, but does have the same goal of the best healing for the patient. In addition to getting a medical history from the client, and determining the patient's constitution (and, sometimes that of the owner!) the first thing I examine on the horse is the tongue color.

 

Really? You can get information from looking at a tongue! It's not that difficult to understand once you break it down. The tongue is a very large and strong muscle. The Chinese see the tongue as an external window of the internal world. Patterns of imbalance within the body will be reflected in tongue color, shape, size, coating, and cracking. The tongue is also a view into the past history of the animal's health.

 

Let's examine this further:

 

Red tongue: Heat,Yin Deficient Heat. Red is typically the color of heat. If you have an injury or a cut that swells, red is the color you see. This is increased bloodflow and dilation of vessels. Typical in hot weather, or in animal's with a fever and inflammation.

Pale tongue: Qi deficiency (wet), Blood deficiency (dry, cracked). Qi (Chi) is the unseen energy of life. Qi and Blood go together - Qi flow is needed to carry blood, but blood is needed to manufacture Qi.  It makes sense that an anemic animal would be pale, and blood deficiency could indicate anemia. A pale, wet tongue shows a lack of flow of Qi - no blood is circulating, so things are pale and wet. This is especially common in older, arthritic horses who may also have a Kidney deficiency.

Purple tongue: Heat and stagnation. When you have a bruise, what color is it? Purple is the color of stagnation. Stagnation is a lack of flow, or a pooling of energy and blood somewhere in the body. This is very typical is chronic pain cases, arthritis, or other chronic issues such as poor saddle fit causing back pain and stagnation.

Swollen tongue: dampness and stagnation. Swelling, such as when you have been sitting on an airplane long-term and you get swollen ankles, can also indicate a lack of flow.

Tongue coatings also indicate health or disease:

White coating: normal

Thick white coating: excess, cold

Slimy: phlegm

Yellow: heat, liver

 

Wow! All that information just from looking at a tongue! And that's just the beginning, as there are also tongue maps, where specific portions of the tongue can be used to diagnose specific organ dysfunction. Start looking at your own tongue, your horse's tongue, your friend's horse's tongue - you will begin to notice stark differences in shape, size, and color.

 

Bute: You use it, but do you understand it?

 

Paste, tabs, apple flavored power, injectable - it doesn't matter which form you are familiar with, Bute is the most common non-steroidal anti-inflammatory in tack trunks world wide. But do you really understand the medication, the effects, the dosages, and what alternatives may be available?

Phenylbutazone is a non-hormonal, anti-inflammatory agent. Chemically, it is described as 4-Butyl-1,2 diphenyl-3,5-pyrazolidinedione, a synthetic pyrazolone derivative, entirely unrelated to the steroid compounds. Phenylbutazone possesses non-hormonal, anti-inflammatory activity of value in the management of musculoskeletal conditions in horses including osteoarthritis.

 

In a study comparing Bute with banamine and ketoprofen, ketoprofen (2.2 mg/kg of body weight), flunixin meglumine (1.1 mg/kg), or phenylbutazone (4.4 mg/kg) IV, was given every 8 hours, for 12 days. Only the Bute group showed significant ulceration and edema of the small intestine and the colon, with some less significant side-effects with Banamine. The Bute and Banamine groups also had evidence of renal disease.  One study had 2 acute deaths in horses receiving both Bute and Banamine at the same time.

 

Bottom line, while a loading dose is appropriate, long-term use should be avoided if possible, and certainly given at a low-dose for chronic lamenesses. Alternatives do exist, and you should consider whether topical Suprass, oral glucosamine-chondroitin, Adequan, or HA (Legend) might be a better choice. And of course, the range of holistic treatments such as acupuncture may also forego the need for Bute.  Finally, it is my personal belief that any horse on Bute, no matter how short term, should be on a gastroprotectant and encouraged to drink plenty of water. Longer term administration should be accompanied by period bloodwork to assess liver and kidney function.

This month's case comes to us from the Wild Horse Sanctuary.  No, I didn't wrangle a Mustang for the sake of the newsletter (though it would have been an interesting study!), but I did work on one of the string horses.

 

"Sunny" was a recently acquired Paint gelding who was being tried out as a trail horse at the Sanctuary. Though he took to his job beautifully, the wrangler noted some soreness in the gelding's back, and asked me to take a look at him upon our return. He wanted to know if this was caused by an old injury, or if the trail work was too much for him or if the saddle needed to be changed (hooray for the Sanctuary - they actually care about saddle fit!).

 

Sunny was a very good patient, but was very sore in his low back. He had 2-3 vertebrae involved in a rub sore from his saddlepad, and had the typical inverted back so common in horses who haven't been asked to engage or carry themselves properly under the weight of a heavy Western saddle and rider.  He had been procured through an auction, and his history was mostly unknown.

 

Sunny's tongue was stagnant, though his pulses were relatively equal on both sides. He was in overall good condition except for the back issue. A chiropractic treatment revealed the following: weak left rear, sore lumbars with rotation and decreased motion at L6, L5, L4, L3, thoracic spine very tight to motioning, tender over shoulders, a few distal limb adjustments, good response to tail pull, and stiff cervicals. Basically, the picture of a horse who has worked very hard, who hasn't ever had VSMT or hands-on bodywork before.

 

So what do you think? Is this chronic or acute? What would you tell the worried wrangler about his horse? What treatments would you recommend to help his sore back - for the nearterm, and the longterm? When you have your ideas,