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Dear list,

The following is the latest on Shahtahr, my 10 yr old Arab
 gelding.  Any input or thoughts on his present condition are welcomed, 
as at this point, I don't know whether he will ever do a ride again :(

Am also wondering if anybody has heard of or used Tildren (tiludronate -
a biophosphonate), a new drug being used in France (manufacturer is
CEVA) for the treatment of navicular sydrome - it supposedly stops the
reabsorbtion of bone and formation of invaginations, allowing the
lesions and channels to fill back in and even out rough surfaces of the
nav bone.  This drug is used in humans for Paget's disease and
osteoporosis.  I can't find much info on long-term effects or safety.
 It is very expensive ($1500 for a one-time 10-day treatment) and not
easily obtained here in the U.S.  Studies show amazing short-term
results so far --  60% or greater sucess rate of restoring bone density
to navicular bones.  Even better sucess rates if treated within 6 months
of initial onset of signs.

Anyway, the update:

It's been 3.5 months since he was grade 3 lame on his right front, and
diagnosed via x-rays, CAT scan, and bone scan as having torn a small
ligament away from medial side of his navicular bone.  The ligament is
called the "suspensory ligament of the navicular bone" or the
"sesamoidian collateral ligament".  It is a rare injury and because of
lack of case studies, his prognosis was unclear.

The bone scan showed a lot of activity on the top medial surface of the
navicular bone, indicating ongoing inflammation and boney changes at the
ligament's attachment site.

He was put into bar shoes (set under) with 2 degree wedge pads and we
got very aggressive with shortening and rockering his toes. He was also
put on a silicon bone supplement called Osteon, by the Platinum
Performance folks.

He has been on stall rest with 15 mins a day handwalking up until now
(3.5 months).

We just returned from our re-check at the clinic, where he got a
followup bone scan and new x-rays.  Results are as follows:

On initial exam, he was pronounced clinically sound at the trot, both on
the straight and lunged in a circle both ways.

X-rays show the formation of two very tiny enthesiophytes (spurs) at the
ligament's attachment site, which was pretty much expected to happen and
they are so small that right now, the vet is not too concerned since he
is trotting sound.

On the down side, X-rays also showed that his navicular bone is now
showing an increase of invaginations (the channels that form on the
distal ridge in a horse with navicular disease).  This is a new
development, and the vet feels that the navicular bone may be remodeling
as a secondary response to one branch of the ligament being torn away
from it, causing uneven torque or pressure on the bone.

This is cause for some concern...we don't know if this will resolve
itself with time as the ligament injury heals completely and the foot
resumes a more normal state or if it will continue to worsen  -
basically a case of injury-induced navicular disease.

The bone scan showed that the site of the initual injury (ligament
attachment site on the top/medial surface of the NB) is now totally
"cold" - no inflammation at all - which is great news.  It glowed like a
Christmas tree on his first bone scan.

But the rest of the navicular bone is now active, but vet said it is
mild at this point.  He showed me scans of horses with NB's that were
really glowing on the screen...Shahtahr's is pretty minimal compared to
those, but it could worsen.  It's an unknown at this time.

I begin re-introduction to exercise tomorrow, starting with 30 mins/day
under saddle at a walk.  After that, add in 5 minutes trot for 3 weeks,
so on and so forth (I've a page-long regimen to follow).  He can keep
progressing unless we backslide and he shows soreness again.

The vet advised keeping him in bar shoes and pads, but weaning him off
the wedges, going down to 1 degree for a while and then nothing - but
keeping the eggbars and pads forever, which I'm not thrilled about.

I've read somewhere that bar shoes really don't help protect/stabilize
the foot as well as was once thought, but I guess the vet knows best.  I
just hate to think of a lifetime in those things and pads...his feet get
so gunky under there.  I hope he can some day go back into his Natural
Balance shoes and even go barefoot during winter.

That's all I know at this point.  Who would have thought I'd end up with
an Arabian with navicular problems, albeit acquired in a roundabout way.

Don't know if he'll ever be a distance horse again - depends on what his
navicular bone does.
I'll have to take it a step at a time.

Will let everyone know how we're coming along farther down the road.

Thanks for reading and any thoughts.  Right now I am trying to decide
whether to ride this out and see what happens in regards to the new
navicular bone changes, or go ahead with the Tildren treatment.

Jennifer





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