Saturday, March 2, 2013

Leg care

One good thing about an absence from the sport of endurance is that I'm revisiting some of my old protocols and evaluating whether they are really effective or not.

If you've been a reader on this blog for a couple of years, you have probably seen a discussion of what I do post-ride to care for Farley's legs and prevent filling as she stands at the trailer after a ride.

Filling isn't necessarily bad on it's own, but it can be a warning sign of an underlying injury. There is variation among individuals. Some horses may be more prone to filling from the beginning. In horses with previous injuries, the leg can be more likely to fill, even if there is no injury. As with anything else, filling is one piece of information to be considered in the entire picture of the animal when making decisions.

There's 2 schools of thought when it comes to leg care.

a. Treat aggressively every time to prevent the filling so it never occurs.

b. Treat minimally so that if there is a problem and the leg fills abnormally, than you know something is up and you can adjust.

I fall somewhere between the 2 (as do probably most people). I don't want to treat so aggressively that I miss something.....but I also know that because of splints and previous soft tissue injury, some filling is normal in Farley after an endurance ride and I want to prevent that if I can.

Let's talk about icing.

I do ice. 20 min on, 20 min off, repeat 2-3 times. The basic theory behind icing is that you are reducing/slowing down any inflammatory processes that are occurring in the leg, and thus hopefully minimizing damage that can occur with inflammation. HOWEVER, there's a thought out there that by icing, you may be preventing a normal physiological, healing response to the work. True, the inflammatory cytokines that are present have damaging effects on normal tissue, BUT there's some protective properties there too that you may be preventing by icing it.

Here's my middle of the road approach to icing. After a normal conditioning ride I don't ice unless there is an apparent injury. I monitor the legs closely if it was an especially hard ride but overall I depend on the body's normal physiological responses to do what is best. After endurance rides I do ice, again - assuming there is no apparent injury, but I don't go overboard, and I don't try to "super cool the legs". If there's an inflammatory response in the legs that I feel warrants that type of cooling, maybe there's a bigger problem that means I need to go back and evaluate my conditioning program and understand why I'm getting that type of response in the leg.........

After icing you can go straight to wrapping (or not), or "poulticing the legs".....or not.

Let's talk about wrapping first.

There are pros and cons of wrapping.

Pro: provide "support" to the leg to potentially reduce filling, especially in a horse standing at the trailer (even considering that it is getting hand walks).

Con: impossible to closely monitor the legs over a period of time.

Again, I historically chose a middle of the road approach.

I do wrap overnight, but not until I have decided whether there is not a problem in the leg. If I finish a ride and don't have any concerns about her legs at the finish, and everything continues to look good an hour or so after the finish (the time it takes me to untack, vet in, ice etc.), I wrap.

If I'm unsure - ie she's NQR (not quite right) but maybe I can't put my finger on it. Is there more filing or heat in one leg than than the other? Was the vet concerned about how she was moving? Was it a tough trail or did she take some funny steps? It's not until I have decided one way or the other (yes I have a problem, or no I probably don't) that I wrap. That way I can continue to monitor it for changes. This is how I caught the issue on the end of the 20MT in 2011 in Farley. She was pulled for tightness in the hind end at mile 96 and trailered back to camp. I waited to wrap until I was ready to go to bed because it was a sandy ride which is historically hard for Farley, and I wanted to make sure everything was good, especially with the left front. During my last check before wrapping there was SUBSTANTIALLY more filling in the left front than the right and I knew i had a problem. I may not have caught that problem if I had wrapped right away.

Let's go back a step. What about treating the leg with something prior to wrapping?

There's a couple of different options.

Surpass - a NSAID drug that is absorbed through the skin. I start with this one because it is the simplest and I know the mechanism. Think of it as bute - but bute that is absorbed directly to the site where it is needed. It's important to remember that this is an honest-to-goodness drug and is prohibited during competition. Additionally, I do not treat legs with this post ride unless there is an issue because I don't want to hide an issue that I should know about - Don't misunderstand me I have no problem slathering on the stuff if I think there is a hint of injury - but I don't fool myself into thinking that now I don't have an injury - by choosing to treat with the drug, it means there's an issue that needs to be addressed beyond just standard ride recovery. The ice-surpass-wrapping routine is the routine recommended by my veterinarian when Farley bowed her tendon. Minx was treated with a furacin sweat wrap (discussed later) the year before for a similar issue....but my veterinarian, having just returned from a conference suggested that we try this new drug, Surpass, based on the evidence he saw at the conference about its action on tendons. We were both really pleased with the results and it's my treatment of choice if there's an issue.

Clay poultice. There's some out there that have ingredients banned for competition by AERC, but I'm referring to the clay poultices that are legal. I see a lot of people using these (legal clay poultices) post ride and although I've never used it, I've been tempted, and I'm considering it for the future. When I asked my vet about it, his comment was that while he wasn't convinced that it did any substantial good, it wasn't likely to do harm, and (most importantly) if there was something wrong, wouldn't cover it up. Sounds pretty good to me, and I'm willing to try it. Like I mentioned above, Due to a variety of insults and injuries over the years, Farley's legs do have a tendency to have some filling after rides and adding something to my routine that minimizes this would be nice. My plan is to use a wet paper over the clay poultice and then put the wrap over that. I'm a very practical rider, and if I don't think it helps, I probably won't bother continuing the practice (my energy at rides could be used for something more valuable in that case), but I think it's worth a shot.

Furacin (nitrofurazone) +/- DMSO. I really struggle with this one. This is what people call a "sweat wrap" and I see it prescribed for lots of soft tissue stuff. After slathering the Furacin on, the wrap is applied directly (the advice I was given for Minx's bow), or is covered by wet paper (like the clay poultice) or covered by suran wrap, and then covered by the wrap. Here's my problem when the treatment. I can't find ANYWHERE definitive evidence that it works, or if it does HOW it works. And unlike the clay poultice, I'm not convinced it it totally benign. Furacin is an antimicrobial that in human medicine was applied topically to burns, that has since been discontinued. It is a potentially carcinogen. When using it, it is recommended that we apply it with gloves. Left too long on the horse it can cause scuffing and hair loss. DMSO is used as an industrial solvent, and has uses in vetmed, primarily as a carrier across the skin for other compounds, and some other uses that have very little relevance to endurance (cerebral edema?). So, what I'm left with, based on this information, is a potential carcinogen that is an antimicrobial that, if used in combination with DMSO may be carried into the skin (depending on how well it binds to DMSO) that some how helps heal soft tissue and/or reduce inflammation? I really have a hard time with this. I've been doing some research over the last 2 or 3 days on this topic, and still have no good idea of the how's and why's. So here is where I am with this therapy:

1. If it works, it falls into the same category as surpass - meaning it does substantially help, and thus could cover up something post ride (and just because you have prevented one clinical sign of an injury doesn't mean it doesn't still exist!!!!!!).

2. Although Surpass is by perscription only and more expensive than the Furacin sweat, at least I know how it works and what I'm dealing with, AND.....

3. Because of no clear anti-inflammatory effect and potential carcinogen status, I'm not sure that this falls into the harmless/benign category and so into the "why the hell not, what can it hurt" category.

I'm a believer that most of the "old" horseman traditions that persist usually have some kernal of truth that underlye them, just waiting for modern medicine to find. AND not everything I consider as helpful can necessarily be explained with science, SO, I'm not someone to immediately dismiss an "old tradition" such as this sweat wrap easily. But, in this case, I'm very uncomfortable doing this to my horse. After all, it's an "old" tradition that pin firing tendons encourages healing, which I can confidently say has been completely debunked. Is the Furacin wrap something that makes the horseperson feel good in the face of an injury where time and patience is the best healer? Is is benign or does it have the potential to do more harm than good?

Vets I respect have recommended this treatment, thus there may be something I'm missing. If you have something with a reference (not from a forum or word of mouth) of how this therapy helps, PLEASE let me know. I will be talking to several vets I know at the AERC convention next weekend to get more opinions.

It would be really nice to have something that REALLY works that is over the counter and cheap - I could buy a lot of furacin for what a tube of surpass costs me. I'm just not convinced, based on my current knowledge, that this therapy has a place in my bag of tricks.

In conclusion: here's a summary of my (revisited) leg care protocol at a ride:

1. evaluate legs.

2. Ice

3. evaluate legs. If everything looks OK, move onto the next step. If there's an issue, move onto the next step. If I'm unsure, STOP, wait. Re-evaluate.

4. If no issue, +/- clay poultice, standing wrap.

5. If issue, Surpass and standing wrap.

I'll let you know how I tweak it in the upcoming season!!!!

 

8 comments:

  1. Yep, that's how I found out that Gogo has done bilateral SDFT injuries in her hinds.... I coldhosed, handwalked, and left her unwrapped for about an hour once she was back in her stall... when I came back to wrap, both those hind legs were HUGE. I'm glad I saw it when I did, or else I would have never known until the following morning.

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  2. A lot depends on the horse, I've never wrapped Chief's legs and with over 13k miles he's got cleaner legs than Bo does, with half the mileage and that I have been wrapping for the last two years. I'm looking at those new compression wraps and waiting for feedback from others on how well they work, as they would sure be a lot easier than wrapping, especially for multidays. One of the best poultices if you have a problem is Numotizine. I keep some in my trailer for just in case. See you in a few days!

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  3. http://www.sstack.com/quilts-standing-wraps/Equi-Flexsleeve/ I have a friend that ordered some and am waiting for feedback.

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  4. I have previously used alot of sweat banadages with the furacin in the days I was eventing and jumping alot. It reduced noticeable inflammation and/or swelling . This was "standard" practice then and I just did it because my vet suggested. I eventually ran into an issue with it causing a chemical burn and it sloughed the hide off my Thoroughbreds back leg. I havn't used the method since for two reasons. I haven't really had any signifigant issues with a soft tissue injury so I haven't really needed to and for those after ride "take care of the legs" , I have found better luck with the clay poultice or rubbing legs vigorously with isopropyl alchohol. I have an older gelding that has always been prone to stocking up. His only job any more is the occasional horseback archery competition which involced 9 canters down a track. I am a big believer in taking care of legs because of the background i have in jumping but especially in the older horses. Rebel gets poulticed and/or iced and that has worked well for him .

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  5. I have previously used alot of sweat banadages with the furacin in the days I was eventing and jumping alot. It reduced noticeable inflammation and/or swelling . This was "standard" practice then and I just did it because my vet suggested. I eventually ran into an issue with it causing a chemical burn and it sloughed the hide off my Thoroughbreds back leg. I havn't used the method since for two reasons. I haven't really had any signifigant issues with a soft tissue injury so I haven't really needed to and for those after ride "take care of the legs" , I have found better luck with the clay poultice or rubbing legs vigorously with isopropyl alchohol. I have an older gelding that has always been prone to stocking up. His only job any more is the occasional horseback archery competition which involced 9 canters down a track. I am a big believer in taking care of legs because of the background i have in jumping but especially in the older horses. Rebel gets poulticed and/or iced and that has worked well for him .

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  6. Love this post. As a recent endurance convert and traditional H/J rider, I am just nervous about legs. I used to ride for 30 minutes and wrap. Now, I'm riding 25 miles and not wrapping (but grimacing and holding my breath a little). I have cooling boots for Pronto (by e-cooline - they are phenom, can actually ride in them if you want) and believe I will try the Fexsleeve that Karen posted about above - as I am super migraine sensitive and always looking for the fastest way to take care of my boy post-ride in case my head kicks in. So far, no signs of leg issues for him but we are early in this endurance adventure.....fingers crossed.

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  7. So........now, 2 months later, after a 50 miler which was way more mileage than I've done in a while, I'm still a bit on the fence whether to do "leg care" or whether it really matters. i've wrapped at rides and had them fill. At the ride a couple weeks ago (that 50....) I had a migraine and didn't do ANYTHING. And aboslutely no filling in the morning.

    I don't think it actually does harm (unless you are administering NSAIDS post ride to a horse that is probably 5% dehydrated) but I'm on the fence whether it really HELPS. Unless there is an actual confirmed injury. I'm not sure that it actually is going to make the difference between there being an injury and not injuried. It will mitigate and injury - but you still have the injury. Not sure it actulaly PREVENTS. Does this make sense?

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    Replies
    1. The NSAID comment was because near the end of the post I talk about Surpass - not necessarily the wrapping and iceing and polticing and other leg care covered here.

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