Q: My horse was diagnosed with navicular syndrome about five years ago. He was put on isoxsuprine and half a gram of Bute twice a day, and we changed his shoeing regimen. He has been sound since, and he remains sound, as long as he gets the Bute and is trimmed on a regular basis. He is now 19 years old. He occasionally becomes lame when the ground is hard--like during the summer when it hasn't rained for quite some time and the flies are bad.

I recently changed barns and veterinarians. The new veterinarian said that the Bute will give my horse ulcers and eventually kill him and recommended injections of steroids and hyaluronic acid (Legend) in the foot. She said the injections should last three months to a year, and if I want to give him Bute, I can do it a few hours before I ride.

I am totally confused, as the original veterinarian felt that the low dose of Bute was okay as long as my horse stayed sound on it. He also felt that keeping a low dose of Bute in his system to keep inflammation down was better than giving a larger dose four to five times a week before I ride. Although I know that Legend shots give good results for joint problems, I thought that hyaluronic acid was for joints and that navicular pain is found in the feet and heels.

Can you help me sort through the pros and cons of Bute vs. injections?     --Barbara Ross, via e-mail

A: This is going to be a complicated answer without seeing the horse, but I have an idea of what you are dealing with in this 19-year-old. Navicular syndrome (better named chronic heel pain syndrome) is very complicated since it involves bones, joints, ligaments, and tendons of the heels of the feet (and yes, these all exist in the foot). Also, the treatment depends on your needs and his. Do you want the horse to be very good for the next few years, or do you want your horse to be the best he can be for the rest of his possibly long life?

First, make sure you're working with a good farrier/veterinary team and that both understand what you want. Second, good podiatry, establishing an easy breakover, is essential. Podiatry is far more important a starting point than drugs and injections. Your horse could be one that goes better barefoot, depending on how much you ride and expect of him.

There is certainly a greater ulcer risk with phenylbutazone (Bute) and flunixin meglumine (Banamine) than with the newer drug Equioxx (firocoxib, a COX-2 inhibitor). The risks with Bute and Banamine are highly dependent on the dose, the number of treatments per day, and the length of time you treat. In addition, you increase the risk further if you expect the horse to show or compete. Certainly, Bute can be reasonably safe in low doses that are infrequently needed. This is especially true in horses who don't travel very far, aren't expected to compete, and live in a relatively stable environment. Infrequent doses just before you ride work well with some horses. With others, you have to leave them on a low dose all the time.

You need to determine the minimum treatment the veterinarian and you are comfortable using. At some point you might have to turn to more aggressive treatment, but from what you wrote, I don't think you are in that situation yet.

About the Author

Joseph J. Bertone, DVM, MS, Dipl. ACVS

Joseph J. Bertone, DVM, MS, Dipl. ACVS is a professor of equine medicine at Western University of Health Science's College of Veterinary Medicine in Pomona, Ca.

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