BUMP ON THE LEG

EQUUS - - Targeted Relief From -

A mis­judged dis­tance in a green hunter class sent rails fly­ing. Cleo, the young mare, took a good whack to her knee from a pole and limped off the course in ob­vi­ous pain. Thank­fully, a ra­dio­graph showed no frac­tures or other se­ri­ous dam­age, but the joint swelled from the trauma, in­di­cat­ing an in­flamed joint, or syn­ovi­tis. Cleo would need sev­eral weeks off to re­cover, and she’d ben­e­fit from an NSAID to help with that process. Which one should we choose?

I rec­om­mend to the owner that we limit Cleo’s ex­er­cise un­til the joint is bet­ter, ap­ply ice and ad­min­is­ter my anti-in­flam­ma­tory of choice for joint is­sues, phenylbu­ta­zone (“bute”), the go-to NSAID for acute joint in­juries. Bute is one of the most po­tent NSAIDs when it comes to pain re­lief as well as one of the most cost-ef­fec­tive. Although horse own­ers of­ten use bute to treat the “limp,” it isn’t given just for pain con­trol. Phenylbu­ta­zone, like other NSAIDs, also fa­cil­i­tates the heal­ing process by con­trol­ling in­flam­ma­tion.

In­flam­ma­tion is a dual-edged sword: It’s a call to arms for heal­ing forces that speeds the cleanup and re­pair process of dam­aged tis­sues. But too much in­flam­ma­tion has a de­struc­tive ef­fect, slow­ing the very heal­ing it’s sup­posed to be aid­ing and in some cases fur­ther dam­ag­ing the tis­sues, even per­ma­nently. In the joint, in­flam­ma­tion cre­ates con­tin­ued de­struc­tion, so we need to con­trol it while mak­ing the horse more com­fort­able. NSAIDs do both of

Stud­ies have shown that higher lev­els of bute in­crease the risk of side ef­fects sig­nif­i­cantly but do not in­crease any of

its ben­e­fits.

th­ese jobs by block­ing the pro­duc­tion of a fam­ily of chem­i­cals known as prostaglan­dins that cause in­flam­ma­tion. The most im­por­tant of th­ese are the cy­clooxy­ge­nase en­zymes known as COX-1 and COX-2. Phenylbu­ta­zone, like most tra­di­tional NSAIDs, blocks both.

Be­cause Cleo weighs 1,000 pounds, I’ll start her at 1.5 grams of bute twice a day (I never give more than two grams twice a day be­cause of the risk of side ef­fects). Stud­ies have shown that higher lev­els of bute in­crease the risk of side ef­fects sig­nif­i­cantly but do not in­crease any of its ben­e­fits. In ad­di­tion to the toxicity as­so­ci­ated with large or pro­longed doses, it’s pos­si­ble for a horse to be es­pe­cially sen­si­tive to NSAIDs, and if so, we might see side ef­fects after just one or two con­ser­va­tive doses. I ex­plain to Cleo’s own­ers that they must mon­i­tor her for signs of loss of ap­petite, loos­en­ing ma­nure or colic, es­pe­cially be­cause the mare is a re­cent pur­chase and we do not know if she has a sen­si­tiv­ity to bute.

We hope to see an im­prove­ment in acute in­juries treated with phenylbu­ta­zone within three days, at which point I’ll back the dosage down to one gram twice a day or even once a day if the horse is still com­fort­able at that level. The goal is to have the horse off of bute within 10 days, at which point the in­jury is healed or healed enough that the body can fin­ish the process with­out the support of med­i­ca­tion.

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