June 22, 2015

(Dan) Hey folks, Dr. Dan from Doc Talk. Thanks for joining us today on the show. Our guest is gonna be Dr. Jim Lillich. He’s an equine surgeon and an associate professor of anatomy and physiology here at Kansas State College of Veterinary Medicine and we’re gonna talk about navicular disease or navicular syndrome in horses. Stay tuned and enjoy the show.

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(Dan) Jim, welcome to the show. (Jim) Thank you. (Dan) Folks, this is Dr. Jim Lillich. He is an equine surgeon and clinician. He also works at the…as an associate professor here at Kansas State University’s College of Veterinary Medicine, in the Department of Anatomy and Physiology. Jim, you’ve seen a lot of cases and you’ve worked with a lot of horses, done a lot of surgeries. One of the world’s experts folks, in equine surgery. And we’re talking about navicular syndrome, navicular disease in horses. So, just kind of what is this? (Jim) Yea, that’s a great question; that’s a great topic. We could spend hours on it and if you can lump it into a lot of things or you split it and I like to split it and talk about truly the degeneration of the navicular bone. And there’s a lot of reasons behind it, but what it is mainly is an issue within that one bone that’s within the horse’s foot. (Dan) And the impact of that bone is? (Jim) It’s a vital anatomical structure to allow the horse to do what it needs to do. So, we know that for sure this is a disease that’s been recognized for a long time. And we’ve been fighting it for a long time. And some breeds are predisposed and other breeds aren’t. What it boils down to is basically an overload. The bone just can’t take what is being given to it, or the biomechanical stress on it. And that leads to several things, Repercussions throughout the whole thoracic limb. If we don’t walk right, because our heel hurts then higher things get damaged up the leg, because we’re just trying to get our self comfortable. And the horse is going to move to keep itself as comfortable as possible, becomes a self perpetuating problem in that foot. So, there’s a lot of things that it could be. Not necessarily the bone. But most of the time, it is the bone that’s the primary problem. (Dan) OK. So, we’re talking about the navicular syndrome and whenever we hear that term in horses, you know, everybody…it just kind of takes your breath away… (Jim) Yea. (Dan) …cause it’s horses. Cause it’s not something easy. (Jim) People don’t want to hear it and I would definitely…it is a terrible thing to label a horse with. And I do believe there’s a syndrome and then there’s a disease. The syndrome meaning, we really don’t have radiographic evidence yet that the bone is completely damaged, but the horse still acts like it…for one it’s lame, it travels like a navicular horse, or a horse that’s lame in its heel. When it’s navicular disease, for me, the bone has definitely got radiographic change to it. It’s been altered. It’s shape is degenerated. And then it might be a tougher task to try to get that horse sound or functional. (Dan) And it sits in a peculiar… (Jim) Yes. (Dan) It’s in the structure. (Jim) Right. It sits in with the…it’s part of the coffin joint. It’s the back part of the coffin joint. There’s a bursa. There’s a synovial lining that allows the tendon to slide behind it. And it’s like a little…it’s a bone that takes the slack out of the deep digital flexor tendon as it functions. So, with small foot to big horse size, and we’ve done that with some of our American Quarter Horses, with more of an upright confirmation meaning the angle between the cannon bone and the phalanges, first, second and third or long pasture and short pasture and then coffin bone. If that’s more upright then that horse, that bone sees more biomechanical stress than it needs to. And then quite frankly poor horseshoeing causes it…or poor foot care can really perpetuate it. (Dan) Awesome. Folks, when we come back, more with Dr. Lillich on navicular disease and some of the clinical signs.

(Dan) Folks, welcome back to Doc Talk. Dr. Dan Thomson here with Dr. Jim Lillich. We’re talking about navicular syndrome or navicular disease in horses. And Dr. Lillich is recognized internationally as an equine surgeon. He’s also an associate professor here at the College of Veterinary Medicine at Kansas State University’s Department of Anatomy and Physiology. And you know, we talked about what it is and how it happens, but what are some of the things that the horse owner’s gonna see. (Jim) Probably the first thing that they see is lameness. And it could be very subtle. It could be a not striding out or stepping out as far as they could. A lot of times lameness is perceived as a shoulder lameness so an upper arm problem because the horse won’t extend itself because its heel is uncomfortable. So he’s anticipating putting that heel on the ground and it’s not comfortable for him. So, that’s probably the first thing that they recognize. With time, that can cause contraction of the horse’s heel, meaning the heel is not as wide as it should be. It causes some distortion to the hoof capsule because again, the horse grows that hoof capsule as he uses it. So if he doesn’t use it correctly the hoof capsule doesn’t grow correctly. So, the lameness is probably the first thing that you recognize and it’s an intermittent lameness, the old term for it, a long time ago, was intermittent claudication. A fancy word right, for just, he’s lame. I think usually a dominant leg. It’s a bilateral problem, but it’s usually one leg that causes more of an issue than the other. So the clinical sign is not performing like he used to, lame, hoof looks a little bit different, doesn’t want to do his job like he used to and hopefully that doesn’t progress to a full head bobbing lame like, you know especially at the trot. You know when we evaluate most of lamenesses. So, those are the main clinical signs. (Dan) And so when someone’s looking at lameness, let’s just go through some of the…as you increase in severity you made the mention of head bob and things like that. (Jim) Right. (Dan) What are some of the things you kind of train clients to look at When it comes to lameness issues? (Jim) Veterinarians look at it a little bit different and everybody’s got their way of doing it, but for clients, it’s a little hard to explain because they AAEP scale goes one through five. And it’s really categorical data, it’s not numerical data. So, when you see it, a head bob in a horse, meaning the head comes down on the sound leg. He’s moving the weight from the unsound or the unhappy leg to the happy leg, down sound, is what we usually say. He’s just moving his weight over. So, I ask a client, can he switch leads correctly? Is it one leg versus the other? When the horse starts to show obvious lameness just at the trot, then that becomes problematic. That means he hurts well enough that he can’t hide that bad limb any more. (Dan) So the first thing you see is kind of a difference in the stride, short strided? (Jim) Shorter stride. (Dan) Not reaching as far. Hoof growing differently and then when they become new lame, it’s down with the sound. (Jim) That’s the easiest way to look at it and sometimes it will get worse when the leg is on the inside of a circle. So, if they were to lope the horse or jog the horse to one side the affected leg usually is more evident on the inside. So, the left leg when they’re going to the left. It’s the right leg when they’re going to the right. (Dan) Awesome. We’re gonna take a break. More with Dr. Lillick after these messages. You’re watching Doc Talk. Thanks for joining us.

(Dan) Hey folks, welcome back to Doc Talk. Dr. Dan Thomson here with my friend and colleague Dr. Jim Lillick. We are talking about navicular disease in horses. And Dr. Lillich is an internationally recognized equine surgeon and is an associate professor in the Department of Anatomy and Physiology here at Kansas State University’s College of Veterinary Medicine. Tickled to death to have you on the show today. Thanks for sharing your time and your expertise with us. So, now, my horse is lame. I need you to fix it Doc. (Jim) Alright, so there’s been a lot of treatments throughout the history of this disease to try to make it better, from injection of toxic substances, to changing of what have ya, to… and you can go right down the line with them, but the tried and true is, let’s get the shoe and the shoeing corrected. Let’s get the horse a foot that he can use and work with it, so if he loads it correctly we’re heading in the right direction. Certainly pain relief plays into that as well. The mildly affected syndrome horses, probably can get through with a case of…with some anti-inflammatories, some non-steroidal anti-inflammatory, phenylbutazone, when they start to get more affected, more alterations to the bone, we get a little bit more aggressive with the therapy. We try to deliver an anti-inflammatory that is more in the area of where it’s needed. So those would include coffin joint injections or even navicular bursa injections. We’re trying to put medications exactly where they’re needed. I know that that probably doesn’t go anywhere unless the horse has got proper shoeing. And I’ve got lot of good friends that are shoers and they teach me a lot about this disease. In one comment just the other day from someone I know said, you know the more I do this I think I have it figured out, the more I recognize I really don’t have it figured out. So, you have to have a shoer that can recognize the individual and get a shoe that works for the horse, so he can actually use the leg. (Dan) Talk to me about the different kind of shoes or what you’re talking about with…where are we trying to get that horse to load then? Stay off the heel? (Jim) Well, we need to support the heel. (Dan) OK. (Jim) And part of it is is the heel needs to spread and flux when there’s weight there. (Dan) OK. (Jim) And when there is no life in that heel so to speak, meaning that it should expand normally as it’s weight bearing and the horse puts weight on it. And when it hurts he doesn’t do that anymore. It just lifts up. Part of that is the shoeing and potentially a nail just too tight and we’re not allowing that shoe to spread. We want the break over to be as quick as possible. So, we roll a toe, we rocker a toe, we do something so when the horse picks the leg up it wants to move forward. And then we support the heel maybe with the shoeing just a little fit full, so that when the shoe hits the ground it takes the brunt of the load first before it reverberates up the body. The egg bar was something that people abused. In the right hands the egg bar is very effective. I think also the egg bar might be seen as a get over the hump shoe. And then you get back into something a little bit more normal, so to speak. But growth and changing the foot growth could take you several months if not a year to do. And there’s other medications that are out there. People are using stem cell therapy. That’s yet to be really documented, proven to work. Tildren therapy which is a drug that doesn’t allow the bone to remodel. Some horses respond, some don’t. The biggest thing we do is shoeing and some pain relief. (Dan) Awesome. When we come back, we’re gonna discuss more with Dr. Lillich about prevention of navicular disease and different things you can do to prevent lameness in your horses. Thanks for watching Doc Talk. More after these messages.

(Dan) Hey folks, welcome back to Doc Talk. Dr. Dan Thomson here with Dr. Jim Lillich who’s an equine surgeon and associate professor at the College of Veterinary Medicine’s Anatomy and Physiology Department. We are talking about navicular disease. We’ve talked about what it is. Clinical signs. Gone to the treatment. And now, is there any way to work with your horse or things you can do to prevent lameness or prevent this syndrome? (Jim) For sure. I think there is. You know the ounce of prevention is worth a pound of cure. I think that holds true for this particular problem. And it might be the poster child for it. You know when you go down and you’re starting with a young horse, you can’t emphasize getting their feet right. And shoeing them correctly from the start is pretty important. But when that horse goes into training, he’s gotta have a foot that he’s real comfortable with using. And if he uses it, then he’s gonna harden his body up. It’s gonna harden muscles, bones, etc. in order to take the training. They’re bred to be athletes. But if you neglect their shoeing and the foot care, then I think you’re gonna run into problems. Some horses are gonna be predisposed to this based on… in some instances genetics, and in other instances use, or a combination thereof. But if you can slow down the perpetuation of the problem… (Dan) Sure. (Jim) I think that that’s very important. So shoeing and keeping the young horse trimmed. Making sure when you go to train you don’t overdo it. And keeping an active eye to make sure that you’re not developing an issue. And we see a lot of young horses with some change to their bone with three or four years of age and they’ve already got the problem. And that means their quality of life might not be very nice. (Dan) Yea. (Jim) And their use is going to be restricted. (Dan) I kind of lighten it to that these athletes today, every one of them wears custom fit orthotics in their shoes. (Jim) Yea, exactly. (Dan) Cause they’re gonna be worked hard, they’re gonna have to do the job, so they’ve gotta have something that properly loads the bones of the feet and lower extremities. (Jim) Exactly. And has replications higher up the leg too. So, prevention, foot care, make sure that you have a farrier, someone that really knows how to trim. Get the shape of the foot as semetric and as normal as possible and make sure that shoeing is or foot is at least ready to work. And then the surfaces that you train a horse on should be solid, good surfaces. You know the state of Kansas, we can’t always predict that right? (Dan) Yep. (Jim) With the rains and the hard rocky pastures and arenas can all be different. But if you start with foot care and do proper training, proper warm up, proper work, proper cool down. And it takes diligence. For the most part you can probably be ahead of the curve and not have to come see somebody that you know is gonna tell you your horse has got navicular disease and the only thing we can do is actually cut a nerve to make him more comfortable. And that’s only gonna work for a couple of years. So, and that’s a really disappointing place to be for everybody, the horse, the client and the veterinarian. (Dan) Well, thanks a million for being on the show. (Jim) Sure. Thank you for having me. Appreciate it. (Dan) Folks, Dr. Jim Lillich, here at the College of Veterinary Medicine. If you want to know more about what Dr. Lillich and I do here at Kansas State University you can find us on the web at www.vet.ksu.edu. Remember, always work with your local practitioner. I’m Dr. Dan Thomson. You’ve been watching Doc Talk. We’re sure glad you joined us today and I’ll see you, down the road.

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