Jessica Jahiel's HORSE-SENSE Newsletter Archives

Blistering

From: Sandy

Dear Jessica:

Could you speak to the question of to Blister or not to Blister. I know that this is a common practice of "Track" vets, in particular race horses. However, we are dressage and this is a big Warmblood.

History: The horse recently developed very mild strain of the suspensory Ligament, specifically the lateral branch of the suspensory ligament with a small chip apically. After three flexion test the horse was made lame. Ultrasound and x-rays showed the chip and some small degree of mottling. This appears to be acute and NOT chronic as expressed by the vet. The vet has advised the usual treatment protocol of: relieve the pain, reduce the inflammation and swelling, provide support, and allow sufficient time for healing, which includes box rest, cold treatment, support bandaging, non-steroidal anti-inflammatory drugs, e.g., phenylbutazone. AND, Blistering. Then, in 60 days ultra sound.

We are not comfortable with the Blistering aspect of the treatment plan. I feel there are other options, such as laser, Magnetic field therapy, ultrasound, etc. Also, when required, laser surgery to removed the chip, if it should progress to that protocol.

We would appreciate your insights for direction:

Thank you very much for being there.

Sand

Hi Sandy! You're right to be concerned. There shouldn't even be a question about whether to blister or not to blister. Blistering is unacceptable. Horses heal in spite of blistering, not because of it. Blistering is NOT a therapeutic modality, it's an outmoded, useless nonsense method that does NOTHING but cause pain and extensive tissue damage. Some track vets still use it, for the same reasons they have always used it: It causes the horse enough obvious damage that even the greediest owner has to allow it some time off during which the original injury may heal.

Human and equine tissues heal - and can be damaged - in the same way. A "strain", in either case, means a tear or a series of microtears. That is to say, the tissue has been damaged.

The process of assisted healing, in both cases, involves two phases. In the first phase, the tendon or ligament begins to repair itself by laying down additional strands of collagen. WHEN they are being laid down and have begun to grow together - but NOT before then - the second phase begins. In the second phase, the alignment of the strands can be affected by gentle exercise - handwalking or, in the case of a very sedate horse, turnout. If the horse is to regain the maximum amount of strength and flexibility in the injured area, the strands need to be aligned correctly, which is to say along the axis of pull. This may not happen if the horse is on full rest for too long, but it also cannot happen if the horse is put back into work too soon. The two-part process isn't complicated. First, the collagen strands need to be laid down and given the chance to grow together (box rest); second, the structure must be stimulated to become properly aligned, through gentle pull (handwalking).

For any tissue to heal - muscle, tendon, or ligament - there are certain basic requirements. Tissue is a live structure. Nutrients and oxygen have to come IN, and waste products have to go OUT. Good blood circulation in the injured area is important because without that, waste products will accumulate in fluid, and the fluid itself can interfere with healing by separating strands that should be growing together.

Tendons and ligaments are tricky, as they are semni-elastic tissue. The injured area can eventually be helped to repair itself, but there's a difference between the original collagen and the strands that are laid down as part of the tissue repair. The new strands are strong, but lack the elasticity of the original strands. In other words - and I'm sure you've heard this before - scar tissue can be very strong, but it doesn't stretch. This means that wherever there is a repaired/healed area, there will be (usually) two lengths of normal tissue joined by a length of scar tissue. I'll try to draw it with an underline:

Before: _______ a simple length of tendon or ligament.

After: __ _ __ a section that is repaired, and two places (shown here by the breaks in the line) where each end of the repaired structure joins the normal structure. Because the repaired section is strong but does not stretch, the rest of the tendon has to do MORE stretching to make up for that one tight, shortened section. The parts now at greatest risk for injury are the two "joins" between the repaired section and the original tissue.

The more scar tissue, the more inflexible the structure. Blistering (and pin-firing, another barbaric practice) cause great damage and build up a large amount of scar tissue. If you handle the leg of a horse that has been blistered or pin-fired in the past, you can feel the scar tissue. It feels hard and tight - it would SEEM to make sense that it would be very strong. But although the scar tissue ITSELF may be strong, its lack of elasticity limits the ability of the entire structure (tendon or ligament) to function.

One warning: There are some vets who are still using a banned substance to inject damaged ligaments and tendons - a mixture of iodine and peanut oil. Don't let anyone get NEAR your horse with this. It's illegal for good reason - it causes damage. If your vet wants to use this - it's sometimes called "McKay's solution" - find another vet ASAP.

Blistering - exterior or interior - is never necessary or acceptable. If what's desired is to increase the interior circulation, there are other, much better choices. The tried and true methods still work -- the best way to increase deep circulation within a leg is still, more often than not, going to involve time, effort, and ice boots. If you prefer high-tech solutions, therapeutic ultrasound and lasers can be used to increase the circulation to the area.

The rest of the treatment plan you describe sounds reasonably "standard" - the vet from whom you get a second opinion will probably be able to make good suggestions about the management and eventual re-conditioning of your specific horse. But in lieu of blistering, I will suggest that you look into the various treatment modalities that DO work.

Discuss them with your vet (or with your new vet!) and decide exactly what the treatment protocol will be, and what your at-home participation will involve. Even if you are able to find and afford all of the latest high-tech therapeutic options, there's a great deal that YOU can do between vet visits and treatments by trained ultrasound or laser operators.

Rest - complete at first, then, when healing has begun, followed by gentle, controlled exercise.

Cold (ice) - ice boots or ice massage at first (for no more than 20 minutes at a time); later, followed by Hot-Cold-Hot. Cold treament should not exceed 20 mins.

Support - bandages or boots such as the ProEquine or SportsMedicine boots

Therapeutic ultrasound

Low level laser therapy

TENS - electrostimulation can increase area circulation, decrease pain, speed healing

NSAIDs - you already know about non-steriodal anti-inflammatories, including Bute. These are given to reduce inflammation. They tend to slow the healing process, but by reducing inflamation, can reduce pain to allow the horse to use the injured area. This can be abused - if used to put a horse back into work before it is ready - or it can be used sensibly, to enable the horse to use a painful area and thus increase the circulation to that area. The vets I respect most tend to take a very conservative approach to healing injuries like the one you've described, and are very aware of the drawbacks of NSAIDs. Time off, ice, and handwalking aren't glamorous treatment methods, but they may be the best. I suggest you find the best possible veterinarian, ask for advice and a treatment program, and then FOLLOW that advice.

With enough time off, and sensible, well-informed owners who are taking a long-term view and are willing to help their horse heal and then recondition it slowly, it's quite possible that a horse will be able to return to full work and have a long career.

Sometimes it can be difficult to determine whether what we are doing is truly for the good of the horse. Decisions about training, conditioning, management, and medical treatments are sometimes neither easy nor simple. The more information we have, the less likely we are to accept a "treatment" that may not, in fact, be therapeutic.

Good luck!

Jessica

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