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Quadrilateral Hyperextension of the Fetlock Joints in a New Born Arabian Colt Treated Successfully with Concentrated Nutritional Supplements Bert H. Brooks, DVM Cache Creek Holistic Veterinary Service Woodland, California
Abstract: (Published in JAHVMA, 2/3/2007) An Arabian colt demonstrated quadrilaterally weak fetlock joints at birth. The condition resisted conventional treatment of wrapping and splinting for over six weeks, and the owner rejected more aggressive therapy (e.g., referral for surgery). Concentrated nutritional supplements were administered. The supplements seemed to correct the condition quickly. When the supplements were discontinued prematurely, weakness of the fetlocks returned. Concentrated nutritional supplementation was re-instituted and the fetlocks returned to normal. Again, administration of the supplements was interrupted prematurely, and again the fetlocks became weak. When the supplements were administered for the entire ninety day period (recommended) the foal returned to normal and has remained normal through maturity.
Weakened flexor tendons, weak fetlocks or weak pasterns are terms used to describe what is generally considered to be a fairly common idiopathic congenital occurrence in newborn foals.1,2,3 The sources cited agree that prognosis is usually good because the condition frequently resolves spontaneously as vigorous foals exercise over the first few days to weeks of life. Experience dictates that on rare occasions, some foals do not strengthen as expected and must be euthanized due to the self-inflicted injuries they incur. References to possible etiologies and approaches to nutritional therapy are missing from the literature. A normal sized Arab colt with very weak fetlock joints quadrilaterally (all ventral fetlock surfaces were weight bearing) was born at 2:00 am on 5/12/1994. There was slight bruising of the vulva of the mare, but she passed her intact placental membranes shortly after birth and was producing a normal amount of rich milk when we examined the pair approximately 12 hours postpartum. The foal was reported to have nursed normally and received colostrum within three hours of birth. A zinc sulfate turbidity test was performed on blood taken from the foal to insure that passive transfer of antibodies had occurred with a result of “normal turbidity,” and a probiotic (10 cc of Fastrack® Gel by Conklin) was administered orally because of neonatal diarrhea. (The Fastrack® Gel was to be kept refrigerated and administered daily for six days at the same dose.) We told the owner and the foal’s handler that we suspected the diarrhea would be corrected within 24 hours following administration of the probiotic, but that the weak fetlocks (probably due to weak flexor tendons) would probably require more time to self correct. Literature indicates and it has been our experience that foals born with weak fetlocks generally strengthen spontaneously within a few days. In some cases where the fetlocks become weight-bearing surfaces, wrapping or sometimes splinting become necessary until the supportive structures gain strength. [Sources cited do not indicate precise time lines for improvement. Our experience has been that foals generally attain normal strength with a few days to two or three weeks. The longer the recovery time, the more questionable the prognosis.] In our practice, one foal with weak fetlocks never became strong and its owner elected euthanasia after four weeks of unsuccessful nursing care. We showed the handler how to wrap the fetlocks in order to protect them from injury. Twenty four hours later we called the foal’s handler who reported that the diarrhea had responded to probiotic therapy within 6 - 8 hours, but that the foal was still weak on all four fetlocks and they were still weight-bearing. She also reported that the foal was very active and it was hard to keep the wraps in place. On May 18, when the foal was six days old, we were called to examine him because while he was gaining some muscular strength, his fetlocks were still weak and weight bearing. His continual movement made it difficult to keep the wraps in place. As a result of movement of the wraps during the day, the posterior fetlocks often bore weight without protection and abrasions and ulceration were occurring. The left rear fetlock was distended with edema fluid and was painful to the touch. (We warned that the joint might need to be drained, even if protection could be provided.) The lateral aspect of the right hock was abraded and swollen because the foal applied pressure to that area upon rising. (It required the colt several attempts to stand, after which he carried the right rear leg, probably due to pain from the hock lesion. While moving to nurse vigorously, the foal carried most weight on the front legs.) The dam had come into heat three days following parturition, and the handler feared that she may have stepped on the foal’s right rear hock because of her increased nervousness. Due to the obvious complications, our prognosis was revised considerably to “Guarded to Poor.” Support wraps were mandatory, even if they needed to be changed several times daily. Oral antibiotics (Tribrissen® 30 mg/kg q. 24 hours) and phenylbutazone (200 mg divided b.i.d.) were prescribed. We recommended that mare and foal be confined to a stall with heavy bedding, but the mare became very nervous and it was determined that the foal might be safer in a larger pasture with plenty of bedding provided in places that the foal might use. On May 19, the swollen right fetlock erupted spontaneously, producing copious amounts of mucopurulent material. The handler had once been a veterinary technician, and she owned the stallion which had sired the colt. She was instructed to clean the wound and liberally apply chlorhexidine ointment (Nolvasan®) under a support wrap, as well as to continue the oral antibiotics. The handler reported that the foal was feeling much better since the opening and drainage of the wound and was running around the pasture with the mare, making it more difficult to keep the wraps in place. The posterior fetlocks were still acting as weight bearing surfaces. Phenylbutazone administration was discontinued. On May 24, when the foal was 12 days old, we examined him again. While the foal was active, his flexor tendons were still very weak with the result that he was bearing weight on all four fetlocks. Only frequent attention to the wraps was sufficient to keep the foal from injuring himself. Over the next month and a half, in spite of a guarded to poor prognosis, the owner and handler spent hours working with the colt. Splints and even specially constructed glue-on shoes (which attempted to keep the toes of the hooves in contact with the ground) were only partially and temporarily successful. During this time, the colt grew in size and increasingly resented his care, but his flexor tendons failed to normalize. During this time period, I had the opportunity to attend a seminar on non-conventional approaches to solving health care problems using natural, mostly organic, concentrated, orally administered nutritional supplements produced by Standard Process®, Inc. I discussed the supplements with the owner as an experimental approach to the foal’s seemingly hopeless problem. The owner and handler were willing to try the nutritional supplements, understanding that a 90 day regimen would probably be necessary. The supplements came in pills and capsules. The capsules were opened and their powdery contents were mixed with the pills. The combination was pulverized in a coffee grinder, and a slurry was made by adding black strap molasses to the powder. The mixture was administered to the colt with a 60 cc plastic dose syringe. The following mixture was used in the numbers indicated on a daily basis, divided b.i.d.:
The following descriptions of the Standard Process® nutritional supplements prescribed are derived from personal communications, company literature and seminars I have attended over the course of several years since 1989. Vitamin and mineral content are sometimes difficult to determine in whole natural foods because they are catalytic in nature and may only be required in very low concentration for normal function of an individual. |
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Endnotes 1. 49th Annual Convention of the American Association of Equine Practitioners, 2003 - New Orleans, LA, USA, (Ed.) Publisher: American Association of Equine Practitioners, Lexington KY. Internet Publisher: International Veterinary Information Service, Ithaca NY (www.ivis.org), 2003; P0604.1103 2. Brown, Christopher, ed., Problems in Equine Medicine, Philadelphia: Jea & Febiger, 1989. 3. Orthopedic Research Center, Colorado State University, http://www.equineortho.colostate.edu/questions/flexural.htm. 4. PMG or Protomorphogen is defined in the book Protomorphology by Dr. Royal Lee as: "... that fraction of the chromosome of the cell which catalyzes the synthesis of new cell protein in growth and repair;" and "The primary organizer of form." See Note on last page. 5. Phillis, J.W., Ed., Veterinary Physiology, Philadelphia: W.B. Saunders Company, 1976, p. 412. 6. http://www.utexas.edu/opa/news/04newsreleases/nr_200412/nr_chemistry041201.html 7. Frobisher, M., Hinsdill, R.D., Crabtree, K.T., Goodheart, C.R., Fundamentals of Microbiology, 9th Ed., Philadelphia: W.B. Saunders Company, 1974, pp. 139 - 140. 8. Painter, J.H., Pub., Biology Today, 2nd Printing, Del Mar, CA: Communications Research Machines, Inc., 1972, p. 339. |
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Ligaplex I - Two capsules supply 245 mg manganese lactate, 85 mg vacuum dried peavine juice, and 65 mg veal bone protomorphogen (PMG)1 extract. Other Ingredients: Calcium lactate, bone meal, oat flour, bovine liver powder, vacuum dried bovine kidney, beet root powder, vacuum dried buckwheat juice and seed, inositol, nutritional yeast, calcium stearate, vacuum dried beet leaf juice, carrot powder, ribonucleic acid, vacuum dried bovine and ovine spleen, bovine adrenal cytosol extract, mixed tocopherols, vacuum dried beet root juice, mushroom powder, vacuum dried whole beet, ascorbic acid, potassium para-aminobenzoate, cyanocobalamin, vitamin A esters, soy bean lecithin, and carrot oil. Ligaplex II - Two capsules supply 160 mg manganese gycerophosphate, 115 mg carbamide [urea], 65 mg veal bone PMG extract and 40 mg vacuum dried bovine liver. Other Ingredients: Calcium lactate, nutritional yeast, defatted wheat germ, bovine heart PMG extract, magnesium citrate, oat flour, carrot powder, inositol, Tillandsia [Spanish moss] powder, vacuum dried peavine juice, ribonucleic acid, vacuum dried bovine and ovine spleen, mixed tocopherols, bovine adrenal cytosol extract, vacuum dried beet root, vacuum dried bovine kidney, mushroom powder, bovine liver fat extract, flaxseed oil extract, vitamin A esters, potassium, paraaminobenzoate, ascorbic acid, rice bran extract, soy bean lecithin, cyanocobalamin, and vitamin D3. Calcium Lactate Tablets - Contains calcium lactate (250 mg) and magnesium citrate (50 mg). The product has a low pH (5.2) to assist in assimilation.2 Biost - Each tablet supplies 170 mg veal bone PMG extract and 6 mg Manganese. Other Ingredients: Calcium lactate, manganese lactate, honey, magnesium citrate and cellulose. Bio-Dent - Veal bone tablet with manganese, B12 and some spleen extract. (Five tablets supply 500 mg bone and vacuum dried veal bone meal.) Other Ingredients: Honey, carrot powder, cellulose, calcium lactate, vacuum dried bovine and ovine spleen, vacuum dried bovine adrenal, manganese glycerophosphate, licorice root powder, peanut bran, and arabic and cellulose gum. Cyruta Plus - Each tablet supplies 325 mg buckwheat leaf juice and seed. Other Ingredients: Bovine adrenal cytosol extract, ascorbic acid, oat flour, and calcium stearate. Catalyn - High quality vitamin/mineral supplement contains defatted wheat germ, carrot powder, calcium lactate, honey, nutritional yeast, vacuum dried bovine adrenal, bovine liver powder, magnesium citrate, vacuum dried bovine and ovine spleen, glycerine, vacuum dried bovine kidney, vacuum dried alfalfa juice, mushroom powder, soy bean lecithin, arabic and cellulose gum, oat flour rice bran extract, ascorbic acid, vitamin A esters, pyridoxal 5-phosphate, vitamin D3, riboflavin 5'-phosphate, and cocarboxylase. Within approximately one week of starting the supplements, the colt began a marked response. Within three weeks the colt was standing, walking and running almost normally on all four legs. We all tended to think that the supplements probably helped, but that the colt’s natural strengthening process had “finally kicked in.” Without informing us, the handler needed to be out of town for a few days. She decided to discontinue therapy because the colt seemed to be almost completely normal. However, within three days of discontinuing the supplements, the colt’s ventral fetlocks again became weight bearing surfaces. The same oral supplements were immediately started again upon the return of the handler who reported what had happened. Within approximately three days, the colt again began to stand with all four fetlocks off the ground. Within two weeks, he appeared completely normal and raced around the pasture. These unexpected responses to changes in therapy indicated that the nutritional supplements might be playing a role in the colt’s recovery. Because of his exuberance and determined reluctance to accept the supplements (the dose of which had been increased in proportion to the colt’s weight gain), the handler asked if we thought it would be safe to discontinue the supplements. We said that the general recommendation was that patients receive at least a 90 day regimen of the nutritional supplements in order to correct nutritional imbalances, but we also understood that restraining and treating the colt were becoming a challenge and agreed that the handler could experimentally discontinue the supplements with the understanding that if weakness returned the supplements should be re-instituted immediately. Again, within three days of discontinuing the supplements, the colt began to show weakness in the fetlocks. Before the fetlocks returned to their former weight bearing state, the supplements were re-instituted and the colt immediately responded with regained strength and vigor. At the end of 90 days on the supplements, the colt was one hundred percent normal in size, strength and movement. Following the 90 day period on supplements, they were discontinued and were not needed again. We were able to monitor the colt’s development and training from 1995 until October, 2003, when he was nine years old and moved out of our practice area. During that time there was never any evidence of weakness or abnormality of gait. Discussion: A natural state of optimum health should theoretically be sustainable with a properly balanced, healthy diet. However, under certain circumstances, attainment of optimum health through proper diet may not be possible and organic decline and/or failure may result. Conditions which may lead to such decline or failure include: • malnutrition, starvation, essential nutrients missing from feed; • infection; • toxicity; • accident, injury; • stress, allergy; • failure of other organ systems (gastrointestinal tract [absorption], endocrine, nervous, etc.); • a combination of the above with advancing age; • other possible events. When failure of an organ system is recognized, it may not be practical to expect a return to robust health through proper diet alone if the natural concentration of necessary nutrients present even in the high quality feeds available is not sufficient for maintenance and repair when they are consumed in normal amounts. Therefore, if the patient is not capable of consuming enough of even the proper diet, additional concentrated nutritional supplements may be necessary in order to provide the level of nutrition required for maintenance and organic repair. We believe that the latter mechanism (correction of deficiency of essential nutrients) is responsible for this colt’s rapid return to health because the colt strengthened when given the supplements, then weakened when they were withdrawn on two different occasions. There was no change in other variables which might explain the sequence of events described. Furthermore, we have seen the mechanism demonstrated in other cases of organ failure in patients by their response to concentrated nutritional supplements, especially where chronic conditions are concerned. Further Discussion: While a detailed search of the wealth of information available on the internet uncovers many opinions and theories concerning nutrition, unbiased scientific investigation of the above is lacking. Most work that has been carried out on “depletion of soil nutrition” by the United Nations Food and Agriculture Organization (FAO) generally deals with the topics of erosion and not allowing soil to “rest” for sufficient periods of time. Sites which “expose” the “obvious” fact that Western agricultural practices employ mostly synthetic “chemical fertilizers” which contain nitrogen, phosphorus, and potassium (NPK) minerals (and sometimes sulfur) even though trace minerals are also extracted from soils with the harvest of each crop ALL seem to have a trace mineral product for sale. While it is true that trace minerals are removed from the soil with each harvest, references to scientific studies which have compared soil nutrient content through the years except on web sites which promote trace mineral products. While it is generally known that trace minerals are of vital importance as components of vitamins and enzymes on which life depends, I am not convinced that they are of use when taken directly by humans because we lack the ability to make many necessary vitamins. Studies which determine whether or not general trace mineral depletion of soils by normal farming practices would be helpful and interesting. A 2004 study by researchers at the University of Texas at Austin, TX, suggests a nutrient decline in garden crops over past 50 years.1 Observation: The serendipity responsible for the preceding events inadvertently resulted in as close to a “controlled experiment” in nutritional supplementation as a private practitioner devoted to the improvement of health of patients is likely to engage. Actual effects of clinical nutritional therapy need to be evaluated at an institution of higher learning. In the mean time, lacking such studies, based on the results of this case report and similar experiences in other practices, I believe that health care practitioners are justified in using high quality nutritional supplements in the treatment of disease, especially that of a chronic nature. [Note on Protomorphogens: Since the book, Protomorphology, by Dr. Royal Lee is out of print and hard to find, I will try to paraphrase his protomorphogen hypothesis as I understand it. While this hypothetical mechanism may be inaccurate, based on results of repeated use of protomorphogen products we find that they function as predicted on a regular basis.
• Endogenous protomorphogens are normally present in the nucleus of every cell where they are isolated from extracellular fluid. Each tissue has its unique protomorphogen type. • During normal cell turnover, some protomorphogens escape from cell nuclei into the extracellular fluid where they are necessary for stimulation of cell growth. (Without small concentrations of protomorphogen present locally, cell growth does not start or progress beyond the lag phase.) • When tissues are damaged, larger than normal numbers of nuclear protomorphogens are released into the extracellular fluid, stimulating the formation of antibodies against the endogenous protomorphogens. These “natural tissue antibodies” (as Dr. Lee called them) combine with all homogenous protomorphogens forming inactive complexes and thereby impede the healing progress because cell growth cannot progress beyond the lag phase.7,8 • When heterogenous protomorphogens from another species are introduced orally to the patient, they combine with the natural tissue antibodies, leaving the homogenous protomorphogens intact so that they can stimulate cell growth and bring about healing.] |